Health bulletin

THE LIBRARY OF THE
UNIVERSITY OF
NORTH CAROLINA
AT CHAPEL HILL
THE COLLECTION OF
NORTH CAROLINIANA
C6lU
N86
V.C31-323
1916/18
FOR USE ONLY IN
THE NORTH CAROLINA COLLECTION
*l
:
^,^
1 This Bullelin. will "be aentfree to arwj citizen of the Stale upoa dequest. j
Entered as second-class matter at Postoffice at Raleigh, N. C, under Act of July 16, 1894.
Published monthly at the office of the Secretary of the Board, Raleigh, N. C.
Vol. XXXI APRIL, 1916 No. 1
CONSERVE THE PUBLIC HEALTH
HEALTH PLANK IN THE PLATFORM ADOPTED BY
DEMOCRATIC PARTY, APRIL 25, 1916
The conservation of public health is now
recognized as a problem demanding considera-tion
of all enlightened governments. We rejoice
in the splendid progress made by our State in
combating diseases among our people, in reduc-ing
our death rate, in increasing the sum total of
health, happiness, and efficiency of our citizens,
and in establishing a justifiable record of health-fulness
as compared with other States of the
Union. We advocate a continuance and strength-ening
of the humane policy now in force in this
State for the protection of the public health, and
the eradication of preventable diseases.
'O
TABLE OF CONTENTS
Editorial Brevities 283
The Dklayed Bulletin 283
Doing a Good Work 283
An Oi'EN Letter 284
Thorough Physical Examination
Nkcessary 284
A Fellow-Worker Symi-athizes. . 285
Public Health and Sanitation. . . 286
Typhoid Fever 286
Model Creed for Health Clues. 288
Health and Morals 2S8
A Typhoid Tragedy 288
Personal Hygiene 289
Taking Care of Business Men. . . 289
Bad Breath 291
The Germ of Life Discovered. . . 291
Overeating Shortens Life 292
Advice on the Use of Patent
Medicines 292
Child Hygiene 293
For the Mental Health of Chil-dren
293
Infant Mortality 293
"Baby" Jones 293
Medical Inspection of Schools. . 294
Why- Xurse Your Baby? 295
Where Typhoid Spreads 296
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
J. Howell Way, M.D., Pres., Waynesville
Richard H. Lewis, M.D., LL.D., Raleigh
.J. L. Ludlow, C.E., . . Winston-Salem
W. O. Spencer, M.D., . . Winston-Salem
Thomas E. Anderson, M.D., . Statesville
Chas. O'H. Laughinghouse,
Edward J. Wood, M.D., .
Cyrus Thompson, M.D., .
P. R. Harris. M.D., . .
M.D.,
Greenville
Wilmington
. Jacksonville
Henderson
Official Staff
W. S. Rankin, M.D., Secretary of the State Board of Health and State Health Officer.
C. A. Shore, M.D., Director of the State Laboratory of Hygiene.
Warren H. Booker, C.E., Chief of the Bureau of Engineering and Education.
L. B. McBrayer, M.D., Superintendent of the State Sanatorium.
J. R. Gordon, M.D., Deputy State Registrar.
G M. Cooper, M.D., Chief of the Bureau of Rural Sanitation.
Miss Mary Robinson, Chief of the Bureau of Accounting.
FREE PUBLIC HEALTH LITERATURE
The State Board of Health has a limited quantity of health literature on the subjects
listed below, which will be sent out, free of charge, to any citizen of the State as long as
the supply la.sts. If you care for any of this literature, or want some sent to a friend, just
write to the State Board of Health, at Raleigh. A postcard will bring it by return mail.
No. 12. Residential Sewage Disposal Plants.
No. 19. Compilation of Public Health Laws
of North Carolina.
No. 23. The Vital Statis^tics Law.
No. 27. The Whole-Time County Health Of-ficer.
No. 30. Measles.
No. 31. Whooping Cough.
No. 32. Diphtheria.
No. 33. Scarlet Fever.
Anti-Spitting Placards (5 inches by
7 inches).
No. 39. Tuberculosis Leaflet.
Anti-Fly Placards (14 inches by 22
inches).
Anti-Tvphoid Placards (14 inches
by 22 inches).
Anti - Tuberculosis Placards (14
inches by 22 inches).
No. 41. Tuberculosis.
No. 42. Malaria.
No. 44. State Policy for the Control of Tu-berculosis.
No. 45. The Control of Smallpox.
No. 46. Compilation of County Healtli Laws.
No. 47. Privy Leaflet.
No. 50. Baby Leaflet.
No. 51. Rules and Regulations of County
Boards of Health.
No. 52. Malaria and What Everybody
Should Know About It.
No. 53. Disinfection After Diphtheria,
Measles, or Whooping Cough.
No. 54. Disinfection After Scarlet Fever.
No. 56. Tuberculosis Leaflet No. 2.
No. 57. Health Helps for Teachers.
No. 58. Fly Leaflet.
No. 59. Typhoid Fever Leaflet.
Sanitary and Hygienic Care of
Prisoners.
No. 60. Cancer Leaflet.
No. 61. How to Nurse a Tuberculous
Patient.
No. 63. Health Catechi.sm.
No. 67. Adenoids.
No. 68. Pellagra.
No. 69. Quarantine Rules and Regulations
for Infantile Paralvsis.
The Child.*
Teeth, Tonsils, and Adenoids.*
How to Live Long.*
Hookworm Disease.*
A War on Consumption.*
Milk.*
Some Facts About Scarlet Fever.*
Tvphoid Fever and How to Prevent
It.*
Ho-vv to B\ii1d a Sleeping Porch.*
Dental Lecturest
Dental Hygienet
*Furnished by courtesy of the Metropolitan Life Insurance Company.
jFurnished by courtesy of Colgate & Company.
EDWARDS » BROUSHTON PRINTING CO.. RAtEISH. N C
omii
PUE>U5AEJ> Sr TML noR.TA CaJquMA 5TATL BQMe.p q^-mlALTM I
Vol. XXXI APRIL, 1916 No. 1
EDITORIAL BREVITIES
THE DELATED BULLETIN
The State Board of Health calls at-tention
to the fact that while this and
several other issues of the Health
Bulletin will appear late, the cause is
in no way chargeable to this Board or
to the Commissioner of Labor and
Printing. Although the printing fund
of the Board has been exhausted,
through the courtesy of the State
Printers, Edwards & Broughton Print-ing
Company, and the Commissioner
of Labor and Printing, the Board will
be enabled to continue the publication
of the monthly Health Bulletin, al-though
in reduced size. Just at this '
time, however, conditions prevailing in
the paper market render it impossible
to secure paper at a reasonable price
in sufBcient quantities to issue the
Bulletin on time. It is hoped that
normal conditions in the paper market
will soon obtain and that the Bulletin
may appear again on time.
Typhoid fever always represents an
unnecessary waste—either of time,
money, or human life.
One dose of anti-typhoid vaccine
does not offer immunity against ty-phoid
fever, but three doses or the
complete treatment does. If you are
going on a trip this summer or on
your vacation, give yourself time to
jMake the three doses before leaving.
'VThis requires but two weeks, as the
j):^oses are given seven days apart.
There are just two simple rules
which, if every man and woman would
heed, would save many an accident
and many a death. They are: Neither
give nor take medicine from an un-labeled
bottle, and neither give nor
take medicine without first reading
the label.
"Go after the stables" and "Clean
up and keep clean" are the two most
successful methods yet found for rid-ding
a town of flies. "There is no
royal road to freedom of flies," says
Mr. L. C. McCormick of Asheville,
"but clean up and keep clean is the
winning slogan."
THOROUGH PHYSICAL EXAMINA-TIO>
NECESSARY
Advice of Dr. Rankin—What Consti-tutes
Tlioroug-h Examination
~~|-' -^ the following correspondence,
^^ containing a letter from a chron-
*®^^ ic sufferer setting forth his ills,
and the advice given him by Dr. W. S.
Rankin, of the State Board of Health,
the need of a thorough physical ex-amination
is urged, and what consti-tutes
such an examination is clearly
suggested. "Go to a well recognized
physician and be thoroughly exam-ined,"
is the keynote of Doctor Rank-in's
advice.
This correspondence is a type of a
feature of health work done by the
284 THE HEALTH BULLETIN
Board through correspondence, and
represents not a small class of people
who frequently call for help.
State Board of Health, Raleigh, N. C.
Dear Sirs:—I have had a very bad
stomach and bowel trouble for the
past two years. My doctors have
treated me for nervous indigestion, but
have^'failed to do me any good.
I have a craving appetite for food
and can eat most anything, but every-thing
I eat except sweet milk seems
to hurt me. My stomach and bowels
pain and ache most all the time and
are worse just after meals than any
other time. I have heart-burn and am
very nervous when trying to work. I
am very much constipated and have
to take oil daily. I have soreness or
tenderness in left side just above left
hip bone and under left shoulder blade.
Have soreness or pains in my back
near or in my kidneys.
I am a married man, 35 years old.
I weigh 1.50 pounds, but am not losing
much in flesh. I do not drink, smoke,
nor chew tobacco. I have had ca-tarrh
of head and throat for twenty
years. I hawk up scales and my breath
smells bad, but I do not cough. Please
consider my case and advise me.
Doctor Rankin's Reply
Dear Sir:—What you need is a very
thorough physical examination. No
intelligent physician could prescribe
for your case without making such an
examination. By that I mean to get
your full history, including the his-tory
of your past life and your hered-ity
history, and then make a thorough
physical examination of you, including
certain laboratory tests. To attempt
to prescribe for you by mail or to pre-scribe
for you without the advantage
of a full examination, clinical and
physical, would be to guess at your
trouble and subject you to a loss of
time and perhaps to expenses of treat-ment
that would be unfair to you.
I would, therefore, advise you to go
to some well recognized physician and
be thoroughly examined. Medical
treatment based upon anything except
a thorough examination is guess work,
and frequently causes patients a loss
of time which results in a curable dis-ease
becoming an incurable one. A
chronic trouble such as you describe,
which has been so costly to you in its
inroads on your vitality and physical
efficiency, should call for a most care-ful
examination. Such an examina-tion
will require a careful questioning
by a physician probably lasting from
fifteen minutes to a half hour, a very
thorough physical examination of your
chest and abdomen bared, a labora-tory
examination of your urine, proba-bly
of your blood, and it certainly
seems to me, from what you tell me in
your letter, that you should be given
certain test meals, have the contents of
your stomach withdrawn through a
stomach tube and tested for the extent
of digestion. If you haven't had such
an examination, go to a physician who
can give you this thorough form of
treatment.
A FELLOW-WORKER SYMPATHIZES
The following letter is typical of a
number of very kind expressions re-ceived
recently regarding the depleted
printing fund of the Board. This fel-low-
worker's sympathy and kind words
of encouragement are sincerely appre-ciated.
The delayed March number of your
bulletin has just come to hand. I am
sorry to read the announcement con-cerning
the difficulty you are having,
and hope that you will soon be able to
get additional funds for continuing the
publication of the bulletin in its origi-nal
form. I can honestly say that
there is not another bulletin which I
look forward to as much as I do yours.
Whenever I have occasion to teach
students about preparing material for
such bulletins, I hold yours up as a
model. I am sure it must be doing a
good work.
With kind regards, I am,
Sincerely yours,
CHARLES BOLDUAN,
Director, Bureau of Public Health
Education, New York City De-partment
of Health.
"To cure is the voice of the past; to
prevent is the demand of the future."
—Buffalo Bulletin.
The one indispensable asset of the
working man is health.
"It is in the power of man to rid
himself of every infectious disease."
—
Pasteur.
TAKING CARE OF BUSINESS MEN
^m
IVlij- the Business Man is Especially
Prone to Arterio Sclerosis
By Chas. O'H. Laughinghouse, M.D.,
Greenville, N. C.
OME phases of preventive medi-cine
can best be taught by boards
of health, some by practicing
physicians; but to acquaint the public,
especially the energetic business man,
that there is such a thing as arterio
sclerosis and that it is largely pre-ventable,
is worth the effort of the
profession as a whole.
We show the consumptive how to
prolong and save his life. We take
care of the defects of school children.
We teach everybody how to avoid in-fectious
and contagious diseases. We
vaccinate for smallpox. We immu-nize
against typhoid. We print and
disseminate information for all kinds
and conditions of men, and we do it
largely through the business man's
influence, his money, his vote, and his
cooperation. Therefore we most em-phatically
owe it to him to give freely
of whatever information we possess
which tends to prolong his life, en-hance
his happiness, and further his
usefulness.
None of us who live long enough
can avoid growing old. But the busi-ness
man's manner of living is so
conducive to the premature appear-ance
of arterio sclerosis, or harden-ing
of the arteries, that he, above all
others, is most markedly prone to ac-quire
it. The best type, today, is liv-ing
too rapidly, burning the candle at
both ends, growing old prematurely,
so much so that it is alarming how
short a time he stays young. Think
of the millionaire widows in the world.
The business man eats too fast and
too much. Many drink too much.
He throws into his circulatory
system without knowing it exces-sive
food and fluids, combined fre-quently
with toxic products, which
cause too early a condition of high
arterial tension. He neglects his bow-els
and thereby causes absorption of
poisonous products from the intestines
which brings about a rise in blood
pressure. He foregoes even mild exer-cise,
which is an essential feature to
the art of living long. If he does not
abuse his body by over-eating and
drinking, and so wear out his splanch-nic
vessels, excessive brain work and
worry and all their attendant evils
become his habit.
He should be taught that he is en-tirely
dependent on his circulatory
system, and that every man is as old
as his arteries; that the thorough
chewing of food is a process that keeps
men a long time young; that requisite
sleep and recreation by bodily exer-cise
is essential to all animal life; that
excessive work, worry and nervous
tension puts a something into the tis-sues
which hardens the arteries and
raises blood pressure; that alcohol
brings about brittle arteries; that sex-ual
excess and syphilis cause arterio
sclerosis.
The prevention of premature arterio
sclerosis may well be labeled a p'ea
for a rational plan of daily living to
286 THE HEALTH BULLETIN
which moderation is the key-note. To
grow old gracefully is an undertaking
which must be begun when young.
Habitual bodily hygiene, not only as to
diet, exercise, temperance, sleep, and
rest, but recreation as well, should be-gin
early in life. There should be men-tal
change. One's life should be planned
so as to bring into each day a diversi-fication
of mental exercise, a diversi-fication
of interests. It is restful—so
much so that some wise man has said
that "rest is but change of occupation."
Hobbies are ofttimes the salvation
of business men. They may be ridden
hard, for they help to bear men away
from daily cares, business ruts and
worries.
The man who can best keep the
balance between his mental and physi-cal
work is the man who accomplishes
most, is happiest, and who, all other
things being equal, will live and pro-duce
the longest.
The trend of modern medicine is to-ward
prevention. We possess State
authority to control epidemics. We
urge over and over again the value of
early diagnosis in all chronic diseases.
We know that many of them—and this
applies particularly to arterio scle-rosis—
can be largely prevented by the
recognition of and the institution of
proper hygienic and medical treatment.
It is every physician's duty to in-struct
the business man in the funda-mental
rules of health. Accurate
knowledge concerning the prevention
of disease should be spread among the
laity. Correct information concerning
the modes of infection and dangers of
waiting until disease is well advanced
places people where they can with
greater certainty nip ill health in the
bud. It is difficult to turn people away
from the habit of having a drug clerk
prescribe for their ills, but they can
be educated out of it. It is unfortu-nate
that most of the pains and aches
that flesh is heir to speedily pass away
with little or no treatment—for herein
lies the strength of charlatanism and
quackery. Unfortunately, yes, for a
man cannot tell whether the trivial
complaint from which he suffers is
any different from the one that was
easily conquered six months ago. But
instead of recovering he grows worse.
Hope leads him to dilly-dally until he
at last seeks medical advice only to
find that the disease has made such
progress that little can be done. Is
the profession or the public to blame?
The fight for existence is keen. Com-petition
in profession and trade is
acute. So much so that to rise above
the average requires exceptional phys-ical
as well as mental powers; there-fore
we should instruct the business
man to consult his doctor twice each
year. He has an expert go over his
automobile at stated intervals just to
prolong its life and efficiency. He
takes an inventory of his business as-sets
and liabilities each fiscal year.
He studies this and that branch of
his affairs with an eye-view to safety
first. He employs this system and
that so as to stop business leaks. He
pays large amounts annually for in-surance,
life and fire. Yet he fails to
have an efficient engineer go over his
greatest business asset, namely, him-self.
And his failure is because he
has not had the importance of it
brought to his attention. The dentist
has his patients return at stated in-tervals,
only to see if all is well. How
much more rational would it be if men
and women past the age of forty had
a careful physical examination made
twice a year just to find out if all is
well.
PfO EMPLOTMEM FOR CIGARETTE
SMOKERS
When two men such as Edison and
Ford join in the crusade against cigar-ettes,
no father or mother can fail to
look with anxiety upon the beginning
of the habit in a son or daughter. Mr.
Ford says to his friend, the American
boy: "If you will study the history
THE HEALTH BULLETIN 287
of almost any criminal, you will find
that he is an inveterate cigarette
smoker. Boys who smoke cigarettes,
as a usual thing, go with other smok-ers
to the pool-rooms and saloons.
The cigarette drags them down. Hence,
if we can educate them to the dangers
of smoking, we shall perform a ser-vice."
Mr. Edison says, in speaking of the
degeneration produced by narcotics
and cigarettes: "Unlike most narcot-ics,
this degeneration is permanent
and uncontrollable. I employ no per-son
who smokes cigarettes." This is
a lesson that every father and mother
may well take to heart. Already some
of the greatest industries of this coun-try,
especially the railways, refuse to
employ any one who uses alcoholic
beverages. Now one of the greatest
industries of this country, that presid-ed
over by Mr. Edison, refuses to em-ploy
any one who smokes cigarettes.
It is not difficult to see that the boy
who learns to use tobacco is loading
himself with a heavy handicap for the
race of life. He is excluding himself
from employment in some of the great-est
industries in the world.—Harvey
W. "Wiley in Good Housekeeping.
OVEREATING! SHORTENS LIFE
BAD BREATH
The cause of bad breath may be the
nose, the tonsils, or the teeth. Al-though
the proof is not conclusive, the
probability is that the most frequent
cause is the absorption of certain sub-stances
from the intestinal tract. The
proof is conclusive that under certain
circumstances aromatic substances
are formed in the intestines, absorbed
into the blood, and excreted by certain
organs. One way to temporarily re-lieve
bad breath is to take a purge and
eat very lightly for three days. Bad
breath is often present in the consti-pated.
Be the weather foul or fair,
Man always needs the good fresh air.
Heaxy Diners Are Bad Risks, Sajs
Life Insurance Actuary
^ XSURANCE statistics show that
rzj, the man who overeats as well as
™™" the man who indulges in alco-holic
drinks is a bad risk, according
to Arthur Hunter, a life insurance
actuary. Mr. Hunter delivered a warn-ing
against over-indulgence in an ad-dress
to a Young Men's Christian As-sociation
recently. He said that the
heavy diner as well as the heavy
drinker was sure of a short life, but
seldom a merry one, because the con-ditions
under which he lived precluded
the full enjoyment of either mental or
physical well-being. But at the top
of the list of life-shortening habits he
placed the use of alcoholic liquors.
"Seventy years ago," said Mr. Hun-ter,
"an abstainer was unknown. When
the first abstainer applied to a large
London company for insurance a spe-cial
meeting of the board of directors
was called to deal with this phenome-non,
and a special premium was de-manded.
Contrary to all expectations,
this man lived to be 82 years old."
—
Daily News, Chicago.
Keep well is the slogan that is
sounding ever louder and louder, and
with this slogan should go the supple-mentary
advice that when sick early
treatment is the safest and surest
treatment. As the twig is bent, the
tree is inclined. It is comparatively
easy to straighten the twig, but the
"inclined" tree is likely to break un-der
the strain of a curative effort.
Just so with the human; defects and
physical impairments are much more
easily remedied in early life than in
the middle or advanced ages, and near-ly
all illnesses are much more readily
cured in their early than in their ad-vanced
stages.
Swat the fly, now.
INFANTILE PARALYSIS OR POLIOMYELITIS
By Db. W. S. Rankin, Secretary of the North Carolina State Board of Health
History
This disease was first, recognized by
von Heine in 1840. A significant fact
bearing on the comparatively slight de-gree
of contagiousness of this disease is
that it was not until 47 years later, in
1887, that it was observed to occur in
epidemic proportions. It is only recently,
since 1907, that the disease has been rec-ognized
in the United States in epidemic
form. Since that time epidemics have
occurred in New Yoi'k City, Massachu-setts,
Rhode Island, Minnesota, Wiscon-sin,
Iowa, Texas, Pennsylvania, and in
lesser degree in other places. The pres-ent
epidemic in the City of New York,
which, at the time of this writing, has
reached the unprecedented level of nearly
7,000 cases, marks the height of the epi-demic
development of infantile paralysis.
Cause
Out of the confusion of conflicting theo-ries
as to the mode of transmission of
infantile paralysis, it seems best to set
down the few established facts regarding
the propagation of the disease, and then
to state the more important theories in
their relation to the facts:
Fact No. 1.—The disease is a disease of
childhood. Over eighty per cent of the
cases are under 3 years of age. In the
present New York City epidemic, ninety-nine
per cent are under 16, eighty-five
per cent under 5, and fifteen per cent
under 1 year of age.
Fact No. 2.—The disease is character-istically
a disease of the summer months,
prevailing most extensively in hot, dry
weather. The disease, unlike the more
typically contagious diseases, does not,
as a rule, tend to spread during school
months, but occurs usually during the
time when the schools are closed.
Fact No. 3.—Infantile paralysis is only
slightly contagious. The disease affects
but a small proportion of those exposed
to it. Of 2,070 persons known to have
been fully exposed to infantile paralysis,
only fourteen developed the disease in
its paralytic form. In four different
schools in each of which occurred a case
of infantile paralysis no secondary cases '
developed. Under ordinary conditions,
cases of the disease are taken into the
general wards of hospitals without isola-tion
from patients sick from other dis- >
eases. As a rule, the incidence of the
disease, that is, the proportion of the
population coming down in an outbreak
of the disease, is not over one person in >
a thousand or two thousand. In smaller
communities the incidence may be
greater. In the present epidemic in New
York City the incidence is about one to ^
five hundred. This heavy incidence is
very probably without a precedent in
the history of infantile paralysis.
Fact No. 4.—The disease is character- '
istically a rural disease, tending to pre-vail
in small towns or cities rather than
in large cities, and in rural rather than
in urban districts. *
Fact No. 5.—The disease shows no se-lective
tendency toward particular social
groups, involving alike the rich and the
|
poor, those living in good surroundings,
well fed and well clothed, and those liv-ing
in the tenements, underfed and poorly
clad. /
Fact No. 6.—The dissase is due to a
germ. This germ has been obtained from
the following sources: (1) From the
body and from the secretions of the noses '
and mouths and intestines of persons
dead of the disease. (2) From the secre-tions
of the noses and mouths and intes- /
tines of persons sick with the paralytic
form of the disease. (3) From the secre-tions
of the noses, mouths, and intestines ,
of persons sick with the nonparalytic
form of the disease, that is, the abortive
or atj^pical cases. (4) From the secre- '
tions of the noses and mouths of persons
THE HEALTH BULLETIN 289-
who have recovered from the disease
several months previously. (5) From the
secretions of the noses and mouths of
well persons who have not themselves
had the disease in recognizable form, but
who have been exposed to persons suf-fering
from the disease. The germ on"
the disease can be inoculated into mon-keys
with the effect of reproducing the
typical disease in the monkey. It is ques-tionable
whether the germ can be inocu-lated
into the monkey without breaking
the skin or mucous membrane of the ani-mal.
The importance of this statement
will later appear. Infected and diseased
monkeys placed in cages v.ith other mon-keys
do not conve}^ the disease to their
companions. The germ of the disease is
not killed by being dried for a consider-able
period of time, which is unlike the
germs of most diseases in that they die
rapidly in the dry state.
Fact No. 7.—The period of time elaps-ing
between exposure to infantile paraly-sis
and the first symptoms of the disease,
technically spoken of as the incubation
period, is not definitely known. It is
usually put down as varying from two
to fourteen days, with eight days given
as the average. However, we know that
in the inoculation experiments on mon-keys,
thirty-three days was the average
time between the inoculation of the mon-key
and the first symptoms of the disease.
In some monkeys nearly two months
elapsed before the disease developed.
There is one case on record where the
monkey was inoculated a year before it
developed paralysis. There is now in
this State a case that left New York five
weeks before the development of the dis-ease.
This variation in the period of in-cubation
of the disease is like the vari-able
period of incubation in hydrophobia,
which is anywhere from two weeks to
two years. In this connection it might
be said that the germ, or poison, that
produces the disease resembles that of
hydrophobia in two respects, namely, that
it can be passed through a porcelain
filter and that it is not killed by drying
and by being kept in glycerine; further-more,
both diseases affect the nervous
system.
Fact No. 8.—The disease appears in two
types of cases, the sporadic case and the
epidemic case. By sporadic cases we
mean cases of the disease that have no
traceable connection with an epidemic,
and that are rarely ever followed by sec-ondary
cases, that is, by other cases.
These sporadic cases are always present
in the State but are so separated by
space and time as to have no demonstra-ble
connection with other cases. With-out
accurate statistics, and basing our
estimate purely upon the number of
deaths from infantile paralysis reported
for the year 1915, seventeen deaths, we
would say that in North Carolina every
year there are about 200 sporadic cases
of the disease. There is no record of the
disease ever having prevailed in North
Carolina in epidemic form, by which, of
course, w^e mean the occurrence of a large
number of cases closely related in space
and time. While there is every reason
to suppose that the sporadic case and
epidemic case is one and the same dis-ease,
this has never been absolutely
proved.
Fact No. 9.—So far, there is no proof
that the incidence of the disease has been
influenced by any measures directed to-ward
its control. For example, the most
strenuous fight that has ever been made
on infantile paralysis is now on in New
York City, and the prevalence of the dis-ease
is greater in New York City than at
other times and places where very little
or practically nothing was done to con-trol
its spread.
THEOEIES
The Theory of Transmission from Per-son
to Person: This theory, based upon
the established fact that the germ occurs
in the secretions of the noses and mouths
of persons sick with the recognizable
paralytic form of the disease, persons
sick with the nonparalytic, unrecogniz-able
form of the disease, persons recover-ing
from the disease, persons who have
290 THE HEALTH BULLETIN
not had the disease, but who have been
exposed to it, assumes that the disease
is spread among the people through the
distribution of the nasal and oral secre-tions
in exactly the same way that mea-sles,
whooping-cough, diphtheria, and
scarlet fever are known to be distributed.
We know that the nasal and oral secre-tions
of people are conveyed to others
in the following ways: (1) The common
drinking cup or dipper: One person uses
the dipper or drinking cup and leaves a
small amount of saliva on the cup or
dipper, which the next person who takes
a drink gets into his mouth. (2) Through
acts of coughing and sneezing without
the use of a handkerchief: It is now
positively known that in acts of cough-ing
and sneezing small invisible droplets
of the nasal and oral secretions are ex-pelled
into the air and float in the air
for variable periods of time, for an hour
or more, and for variable distances, for
twenty or thirty feet. Persons coming
into an atmosphere containing infectious
droplets breathe them in and become in-fected.
(3) Through dried expectoration:
A person spits on the sidewalk or on the
floor, the expectoration dries, moving feet
and brooms grind the dry expectoration
into floating or wind-borne dust, the dust
is breathed in, and if infectious it may
cause disease.
This theory of transmission of infantile
paralysis from person to person has to
assume, in order to explain the small
number of cases of infantile paralysis in
proportion to the population, that but a
small number of those who get the germs,
that is, those who become infected, are
susceptible to the disease. We know it
to be a fact that variable degrees of sus-ceptibility
to different diseases exist. To
illustrate: If a hundred children who
have never had measles are thoroughly
exposed to measles ninety-nine will have
measles; of a hundred children who have
never had whooping-cough, but who have
been exposed to whooping-cough, ninety
will have the disease; of a hundred chil-dren
who have never had scarlet fever,
but who become exposed to scarlet fever,
fifty will have the disease; of a hundred
persons who drink water from a typhoid-polluted
well, twenty-five will have ty-phoid
fever and seventy-five will escape.
In infantile paralysis our theory assumes
that the susceptibility of exposures is far
less than in any of the above.
This theory explains the lack of ability
to control the prevalence of the disease
by assuming: First, the existence of
many abortive, atypical cases of the dis-ease
which are not diagnosed as infantile
paralysis on account of the mildness and
on account of the absence of the charac-teristic
symptom, paralysis. Second, the
existence of a large number of persons
infected with the disease but not sick
from it, that is, "carriers." The theory
assumes, for example, that in New York
City where there are at present about
7,000 persons now sick or convalescent
from the recognizable form of the dis-ease,
and a great many others with the
disease so slight in its manifestations as
to have escaped recognition, there are
from fifty to one hundred thousand car-riers,
that is, persons who have not had
the disease, who are not sick from the
disease, but who in some indirect way,
usually without knowing, have come in
contact with and been infected by a case
of the disease. We know that when diph-theria
is prevailing epidemically in a
town or city that, in addition to those who
are suffering from the disease, there are
from three to five per cent of the popula-tion,
as shown by laboratory examination,
infected with diphtheria germs. In other
words, if in a city of 25,000 population,
there occurred in the course of six, eight,
or ten weeks a hundred cases of diph-theria,
there would be walking the streets
of that city from 500 to 1,000 well persons
with diphtheria germs in their throat.s.
The "carriers," the persons walking
about on the street, in the postofflce, in
the street cars, and carrying the germs
with them, are the more dangerous infec-tious
agents in the community, and not
the persons with the germs who are con-fined
to their room. In diphtheria we
can detect "carriers" by a very simple
THE HEALTH BULLETI]>r 291
examination of the throat, but in infantile
paralysis we can not detect "carriers,"
because the detection of a "carrier" de-pends
upon producing the disease in a
monkey through the inoculation of the
monkey with the throat secretions of the
supposed "carrier." Monkeys are not
available in sufficient numbers for mak-ing
wholesale tests for "carriers."
The ^Veakness of This Theory: First,
if infantile paralysis is conveyed like
measles, whooping-cough, diphtheria, and
scarlet fever, through some form of ex-change
of the nasal and oral secretions
of people, then the disease should occur
at the same seasons of the year when the
other diseases conveyed in this way pre-vail,
that is to say, during the school
months. It is in the school, of all places,
especially in the school with the common
dipper and open bucket and the school
where children are allowed to sneeze and
cough into the air without using a hand-kerchief,
that these secretions are ex-changed.
Second, many cases of infantile
paralysis are found in the most isolated
rural communities, and the most careful
and trustworthy history of these cases
go to show that neither the victim nor
any other member of the household has
been to any place where the disease pre-vails,
and further, that no person coming
from any place where the disease prevails
has visited such a household. In other
words, there are many cases of this dis-ease
so isolated that it would seem that
the only common bond of communication
between such a person and other cases
of the disease could be the United States
mail. These extremely isolated cases go
to suggest that some origin other than
contact with another case is necessary in
explaining the cause and transmission of
this disease. Third, one infected monkey
placed in a cage with many uninfected
monkeys does not convey the disease to
the other monkeys.
The Theory That the Disease Is Carried
by Insects: This theory would explain
the greater prevalence of the disease du-ring
hot weather, also the greater preva-lence
of the disease in rural districts, as
the insect population is greater in the
summer and in the country than in the
winter and in the town or city. Dr. Rose-nau,
of Harvard University, once thought
he had transmitted the disease through
the stable fly (not the ordinary house fly),
but he himself and others have since
failed to confirm the experiment on which
he made this claim. In the experimental
production of the disease in monkeys it
does not seem to be sufl^icient to simply
place the germs on an uninjured mucous
surface like the throat; an injury, a break
in the lining membrane, seems necessary
for infection. This is a point in favor
of the bite of an insect as the means of
transmission.
The ^Veakness of This Theory: First,
it does not explain the occurrence of spo-radic
cases, by which is meant cases
without any traceable connection with
any epidemic of the disease. Nor does
the insect theory explain the irregular
distribution of epidemics. For example,
if the epidemic occurrences of the disease
in 1908, 1909, 1910, in Minnesota, Ne-braska,
Iowa, and Kansas were second-ary
to the epidemic in New York City in
1907, as is generally supposed, how is it
that the insect carrier should pass
through Chicago to the western epidemics
without involving Chicago? In 1910 there
was an epidemic in Washington, D. C,
and a smaller one in Philadelphia, but
Baltimore, between the two cities and on
the main route of travel, escaped. Sec-ond,
the insect theory again fails to hold
water in that children almost solely are
infected and adults escape, uuless we as-sume
that adults are not susceptible and
children are. It is interesting to know
that in the present New York City epi-demic
among the 30,000 institutional chil-dren
living in different institutions in dif-ferent
parts of the city, there is not a
single case of the disease; and that on
Barren Island, where much of the gar-bage,
many of the dead animals, and other
city wastes are carried for incineration,
an island separated from the rest of the
city with a population of 1,700 people
with 200 or 300 children, there is not a
292 THE HEALTH BULLETIN
single cate of infantile paralysis. It
would seem that, with an insect carrier
as active as the present epidemic in New
York City would indicate, there should be
a few cases in some of the institutions
and on Barren Island.
The Dust Infection Theory: This the-ory
was suggested by Dr. H. W. Hill, State
Epidemiologist of Minnesota, as follows:
"With regard to the relation of dust,
and so on; we had a great deal of dust in
the beginning of the outbreak (epidemic
in Minnesota in 1909), when there was
notably hot weather. The corn was actu-ally
drying up. A most striking fea-ture
in connection with this was in Wi-nona.
There were 34 cases which oc-curred
up to the 5th of August. Almost
every case had been on unwatered streets.
They began to water the hitherto unwa-tered
streets on the oth of August, and on
the 12th of August the last case occurred.
There was not another case in Winona, a
town of about 20,000 inhabitants, although
there were cases in the surrounding coun-try
which continued for three or four
months after that.
"There was a somewhat similar experi-ence
in Eau Claire, Wisconsin. It would
seem to me that dust must be a factor in
the disease. For that reason, I am rather
inclined to think that probably the car-riers
of this disease may be found
amongst the lower animals, because, of
course, the only thing we can think of in
dust that can be likely to be a serious
matter is the excreta of animals, espe-cially
of the horse, because the street
sweepings and dust in general of the
street is about half horse manure. I
think fifty per cent of the dust in the
streets of a city is horse manure."
As is pointed out above, the germ or
virus of the disease will live in the dry
state and, therefore, may be capable of
conveyance through dust. The prevalence
of the disease during hot, dry, dusty
weather is corroborative of the dust route
of infection. Its more frequent occur-rence
in the smaller towns and cities and
in country districts where highways are
unpaved and unwatered, as compared
with its less frequent occurrence in larger
places that have well-paved, sprinkled
streets, is suggestive of dust-borne infec-tion.
It seems to be an established fact
that the disease did not prevail in epi-demic
proportion much before the year
1880 or 1890, and that the number of epi-demics
since that time have been steadily
increasing. This fact might be made to
accord with the dust theory of infection
on the ground that a growing civilization
with a greater travel creates more dust
than we had in former times.
The Weakness of the Dust Theory:
Adults do not have the disease in the
same proportion as children, and adults
are as much or more exposed to dust
than children. This fact can be recon-ciled
with the dust theory of infection by
assuming, what seems to be certainly the
case, that children have a far greater
susceptibility to the disease than adults.
The Theory of Auimal Infection: The
occurrence of paralytic diseases among
domestic animals, the dog, cat, chicken,
horse, cow, etc., has suggested that in-fantile
paralysis might be a disease com-mon
to these domestic animals and hu-man
beings, and might, therefore, be con-tracted
from domestic animals. Careful
experimental investigations have failed to
show any relation between paralytic dis-eases
of these lower animals and infantile
paralysis. It is impossible to infect the
lower animals with the virus of infantile
paralysis taken from either infected mon-keys
or children; conversely it is impos-sible
to infect monkeys from animals suf-fering
with paralytic diseases. There is
no evidence to show any connection be-tween
disease of domestic animals and
infantile paralysis.
Control
To control the prevalence of this dis-ease
we endeavor to break the infectious
chain. It would be easy to deal with the
disease if it were known to be due to dust,
for then frequent sprinkling would serve
as an effective agency of control. As we
do not know that the disease may not be
checked in this way, it is well enough, in
epidemics of infantile paralysis, to see
that the streets and much used roads are
kept damp. While it is not likely that the
disease is contracted from domestic ani-mals,
it is not only possible, but extremely
THE HEALTH BULLETIN 293
probable, that dogs and cats and other
pets coming in contact with infected
homes and sick children may, through
association with other children, serve as
a means of distribution of the infection;
therefore, dogs, cats, and other pets,
should be carefully excluded from in-fected
quarters and infected people.
Screening of the sick room is simple and
cheap, and should be carried out, for it is
possible for flies to serve as mechanical
carriers of the poison just as in typhoid
fever. If the disease is found to have
some unknown animal or insect origin, it
would then probably be evident that none
of the methods that have been adopted
for the control of the disease were in the
least effective. If it should be found to
be carried by "carriers," and if what
seems probable should be found to be
true, namely, that the proportion of car-riers
to the number of victims of the dis-ease
is very large, the problem of effect-ive
quarantine would be so extremely dif-ficult
as to be almost worthless.
For detailed, specific rules and regula-tions
governing the control of infantile
paralysis, the reader is referred to Spe-cial
Bulletin No. 69, which contains the
rules and regulations adopted by the Con-ference
of State Health Officers with the
United States Public Health Service on
August 18, 1916. This bulletin can be ob-tained
from the State Board of Health.
Origin of Epidemics.
Contagious diseases prevail sporadic-ally,
endemically, epidemically, and pan-demically.
By the sporadic occurrence of disease
we mean the occurrence of single cases
widely separated by both space and time
from other cases and without traceable
connection with other cases.
By the endemic occurrence of disease
we mean the continuous existence of a
few cases in a place. For example, we
may say that diphtheria is endemic in
New York City, by which we mean the
disease is never completely eradicated
from the City of New York.
By the epidemic occurrence of disease
we mean the occurrence of an unusually
large number of cases of disease closely
related in time and space and showing a
traceable relation to other cases.
By the pandemic occurrence of a dis-ease
we mean the rapid invasion of large
territories by a disease, the best illustra-tion
of which was the pandemic of grip,
or influenza, which started in Russia
some time about 1890 and in one year
traveled around the world.
Explanation of sporadic cases: There
are probably two explanations of spo-radic
cases: A case of scarlet fever or
infantile paralysis develops in the coun-try
or in a town. There have been no
other cases there for months. It is pos-sible
that some person who had recov-ered
from scarlet fever or infantile paral-ysis,
or who had never had the disease
in recognizable form, but who is a car-rier,
met the sporadic case at a soda
fountain, at the rim of a common drink-ing
cup or dipper, or coughed or sneezed
in a street car or postoffice close to the
victim of the sporadic disease, and in
that way caused the sporadic case. The
second explanation of the sporadic case
is especially worthy of consideration in
connection with infantile paralysis. This
explanation would ascribe the sporadic
case to a prolonged period of incubation.
In discussing the cause of the disease, it
was stated that, like hydrophobia, the in-cubation
period, the time between the in-fection
and the occurrence of the disease,
was variable, in inoculated monkeys thir-ty-
three days. One suggestive instance
was cited in which a monkey had the
disease a year after it was inoculated.
So many sporadic cases may be cases of
infantile paralysis infected at the time
of an epidemic, but that come down after
exceptionally long periods of incul)ation.
Explanation for the endemic occur-rences
of disease: Diseases are only en-demic
in very large populations and
where the disease is highly contagious.
It is the smouldering fire, smouldering
usually because the susceptible popula-tion
of a place has been exhausted by an
294 THE HEALTH BULLETIN
epidemic preceding the endemic continu-ance
of the disease.
Explanation of epidemics, or how spo-radic
cases become highly contagious and
epidemic: Under artificial conditions in
the laboratory we may take a disease
germ that has been cultivated or grown
outside of an animal, in a test tube for a
long time, and if we endeavor to produce
disease in an animal by inoculating it
with such a degenerated germ, we find
that we must use, say, for illustration,
ten million germs to kill the animal.
Now we find that if we take this germ
from the animal which it kills and inocu-late
it into a second animal that we can
kill the second animal, say, for illustra-tion,
with a million germs. Again, if we
take the germ from the second animal's
blood and inoculate a third animal, we
can kill it with ten thousand germs; from
the third dead animal we can kill a fourth
with cne thousand germs, and so on, each
successive inoculation requiring fewer
germs for producing a fatal effect. Such
a process of educating a germ to kill, of
raising what the laboratory man calls
the germ's virulence, may be something
like what takes place under natural con-ditions
when a sporadic disease blazes into
an epidemic. We will say, for illustra-tion,
that the sporadic case happens to
be in a child of great susceptibility to the
germ; the germ grows easily and vigor-ously
in such a child's body. By some
chance happening, a second and a third
susceptible person contract the germs,
and there is an increase in the disease-producing
power of the germs. The germ
with increased disease-producing power
then affect a large part of those exposed
to it, an epidemic resulting.
The explanation of pandemics would be
the same as the explanation of epidemics
except the disease-producing power of
the germ would be still more highly
raised.
Farts of Body Affected
There is reason to believe that the germ
or poison of this disease passes through
the upper part of the nose and throat
into the cranium and from there into the
spinal cord, which is directly connected
with the cranium, or brain box. It is
probably for this reason that many caseb
of the disease in the early stages are
characterized by a certain amount of cold,
that is, inflammation of the nose. The
poison or germ, en reaching the spinal
cord, causes an inflammation of the front
part of the cord, usually the front part of
the lower end of the cord. The germ,
however, may cause an inflammation of
any part of the central nervous system,
the brain or the cord or both. The part
of the cord involved in the disease process
is that part that has to do with movement
of the muscles, and of course when this
part is destroyed motion is lost, paralysis
ensues. The part of the body paralyzed
most frequently is shown in the following
table, which is based upon 560 cases:
One lower extremity 229 cases
Both lower extremities 176 cases
General paralysis all extremi-ties,
and more or less of
trunk 79 cases
One lower and one upper ex-tremity
36 cases
Both lower extremities and one
upper extremity 16 cases
One upper extremity alone 14 cases
Both upper extremities 2 cases
All other varieties 8 cases
Symptoms of Infantile Paralysis
In this disease there are two sets of
symptoms which occur either separately
or in varying combination. In one set
there are those symptoms characteristic
of an invasion of the body by disease-producing
germs. In the other set there
are symptoms indicative of an injury to
the central nervous system, more espe-cially
an injury of the spinal cord.
Symptoms of germ invasion are chilly
feelings, of a distinct chill, fretfulness,
irritability, headache, fever from 100 to
104, increased pulse rate, loss of appetite,
sometimes vomiting, usually constipation,
and, in some epidemics, a little cold or
sore throat, indicating the point of en-trance
of the germs into the body. Occa-sionally
there are muscular twitchings
or even convulsions.
THE HEALTH BULLETIN 295
The symptoms indicating an injury to
the spinal cord, and associated with the
above symptoms of infection, are pain in
the back, especially marked in the calves
of the legs and the nape of the neck.
Bending of the body forward, flexing the
head on the neck or the thigh on the body
intensify the pain which is resisted by the
child. Usually within from one to three
or four days after the onset of the symp-toms,
paralysis of some part of the body,
as indicated in the foregoing table, is ob-served,
or, perhaps we had better say,
iiiay be observed.
This brings U5 to a consideration of
what is known as the abortive or atypi-cal
cases, by which we mean cases of
infantile paralysis in which there is no
paralysis, paradoxical as this may sound.
These cases of the disease characterized
by the symptoms of germ invasion only
—
and these symptoms may be very slight,
barely noticeable in many cases—are not
recognized as cases of infantile paralysis
except in epidemics and under suggest-ive
associations. For example, one child
in a family has the typical combination
of symptoms with paralysis of one leg;
another child in the same family has a
little cold, a little elevation of tempera-ture,
some chilly feelings, loss of appe-tite;
maybe it vomits once or twice and has
a little pain in the back. These symptoms
pass away in a day or two. A third child
in the same family is merely indisposed
for a day, does not care about playing,
lies about on the lounge. These last two
children, with no paralytic involvement
and not associated with another case of
paralysis in the family, would never be
suspected under ordinary circumstances of
having infantile paralysis. Nevertheless,
inoculation experiments have shown that
•such abortive cases as we have described
are true cases of infantile i)aralysis. The
important point in this connection is that
in every epidemic of infantile paralysis
there are a large number of abortive and
atypical cases of the disease, cases with-out
paralysis, cases with mild symptoms,
many with symptoms so mild as not to l)o
recognized as being sick at all. Such per-sons
do not themselves suspect the na-ture
of their trouble, no physician ever
sees them, they are not reported for quar-antine,
and usually serve as one of the
most important sources of an epidemic.
Another interesting type of the disease
is the paralytic case with only a few or
with unnoticeable symptoms of germ in-vasion.
A case something like this: A
child three years old is a little bit fretful
in the afternoon, doesn't have much appe-tite
for supper. The next morning, when
the child is being dressed, it is noticed
that one arm or one le^ is weak or limp.
Treatnieiit for Infantile Paralysis
Call in your family physician as soou
as you have reasonable grounds to sus-pect
the presence of the disease and leave
the treatment to him.
ADVICE ON THE USE OF PATENT
MEDICINES
For weak lungs—Purchase a nice cha-mois-
lined chest protector. Put it on your
pet poodle dog, and take ten deep inspi-rations
(breaths) slowly before an open
window each morning. Retire to a warm
bath room and take a cold sponge above
the waist line. This do daily.
For constipation—Take three or four
of Dr. Patent Medicine's Pink Pills. Roll
each pill around the block, using your
hand as propeller. Drink one pint of cold
water before breakfast and at bedtime.
Eat with regularity less meat and more
vegetables. Wash your teeth with a tooth-brush.
Don't forget to thoroughly masti-cate
your food.
For dyspepsia—Procure a box of Char-coal
Dyspepsia Tablets. Put them in your
flower pot. Charcoal is good for house
plants. Go to your dentist and have your
teeth cleaned and filled. Avoid anger. If
fatigued, rest before eating. Select a
good, wholesome diet, avoiding condi-ments
and spices. Avoid midnight
lunches, consisting principally of salads
and coffee.
296 THE HEALTH BULLETIN
WHERE TYPHOID SPREADS
There is probably no communicable
disease in this country the spread of
which we know with as much cer-tainty
as typhoid fever. The manner
in which it spreads or the way by
which it reaches human beings is a
sordid story. So filthy are the facts,
as well as the factors, in the spread of
typhoid fever, that for this reason it
has been called the "national dis-grace."
The plain facts about its spread are
these: The germs are found only in
open-back privies, stables, garbage
cans, etc., to unscreened kitchens, din-ing
rooms, and dairies. They infect
food and drink with typhoid germs,
causing unsuspecting human beings to
contract the disease. Personal un-cleanliness,
particularly of the hands,
is another means of spreading the dis-ease.
The accompanying, picture shows
plainly the surroundings conducive to
typhoid—an open fly-exposed privy and
barn, unscreened kitchen and dairy,
and fly-infected food and drink. The
W
^Hp^*^"^ .„--=
HOW WE GET TYPHOID.
the discharges of the human body,
either in the excreta or urine; these
have to be swallowed, usually in wa-ter,
milk, or with other food, before a
human being can have typhoid; the
three principal factors in the spread
of typhoid are filth, fingers, and flies;
and the control of typhoid fever is
practically the control of these three
factors.
Filth contains the germs of typhoid,
and is carried to food and drink main-ly
by fingers and files. Flies go from
flies go directly from the stables, the
privy, and the dog to the cakes and
pies on the table. Such conditions,
besides being disgustingly filthy, are
an open door to disease and death.
Screen the doors and windows of the
house and milk room, protect the well
and make the privy fiy-proof by build-ing
it fly-tight down to the ground and
placing it over a pit two or three feet
deep by two or three feet square, and
have it at least two hundred feet from
the well.
PuMslvedb^ TnE.^°RTACAR9LI/^/\ STATE. D^ARDs^AmLTA
1 This BulkliAwillbe 5er\X free to arxg citizerx of the Stale upoi\ request !
Entered as second-class matter at Postoffice at Raleigh, N. C, under Act of July 16, 1894.
Published monthly at the office of the Secretary of the Board, Raleigh, N. C.
Vo.. XXXI MAY, 1916 No. 2
Moving Picture Health Car
The State Board of Health has fully equipped this car with a powerful
electric lighting plant, motion picture machine and accessories, together with
a large selection of health and comic films, all of which is in charge of a com-petent
lecturer and machinist. Would you have this car come to your county,
give moving picture health entertainments in a dozen or more places, and wage
a vigorous educational health campaign for from three to six weeks ? Read
pages 20 to 23, inclusive.
TABLE OF CONTENTS
AsHEViLLE Puts Fihst Things First 19
Another Knock-out 19
Public Health and Sanitation 20
Teaching Health by Motion Pictures 20
Hookworm Disease 23
Wht Is A Tonsil? ..- 25
Personal Hygiene 25
Spitting Unnecessary 2(i
Guard Your Health by Watching
Your Kidneys. 26
"Make Health Catching" - -- 27
The Pace That Kills.... 28
It Cost Little to Live a Healthy
Life 29
When Pebuna Was at Its Best 29
Foxes and Tanglefoot 29
Child Hygiene 30
For the Mental Health OF Children 30
Infant Mortality... 30
"Baby" Jones 30
Medical Inspector of Schools 31
Drink More Water 31
A Fool's Paradise. 31
Your Child's Birthright.. 31
Fresh Air and Why. 32
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
J. Howell Wat, M.D., Pres., Wavnesville
Richard H. Lewis, M.D., LL.D., Raleigh
J. L. Ludlow, C.E., . . Winston-Salem
W. O. Spencee, M.D., . . Winston-Salem
Thomas E. Andeeson, M.D., . Statesville
Chas. O'H. Laughinghouse, M.D.,
Greenville
Edwaed J. Wood, M.D., . . Wilmin^on
Cteus Thomi'SON, M.D., . . Jacksonville
F. R. Haeeis, M.D Henderson
Official Staff
W. S. Rankin, M.D., Secretary of the State Board of Health and State Health Officer.
C. A. SHfcEE, M.D., Director of the State Laboratory of Hygiene.
Waeeen H. Bookee, C.E., Chief of tlie Bureau of Engineering and Education.
L. B. McBeatee, M.D., Superintendent of the State Sanatorium.
J. R. Gordon, M.D., Deputy State Registrar.
G. M. COOPEE, M.D., Chief of the Bureau of Rural Sanitation.
Miss Maey Robinson, Chief of the Bureau of Accounting.
FREE PUBLIC HEALTH LITERATURE
The State Board of Health has a limited quantity of health literature on the subjects
listed below, which will be sent out, free of charge, to any citizen of the State as long as
the supply lasts. If you care for any of this literature, or want some sent to a friend, just
write to the State Board of Health, at Raleigh. A postcard will bring it by return mail.
No. 12.
No. 31.
No. 32.
No. 89.
No. 41.
No. 42.
No. 47.
No. 50.
No. 52.
No. 53.
No. 54.
No. 57.
No. 58.
No. 59.
No. 60.
No. 61.
No. 63,
No. 67,
No. 70.
No. 71.
No. 72.
No. 73.
Residential Sewage Disposal Plants.
Whooping Cough.
Diphtheria.
Tuberculosis Leaflet.
Tuberculosis.
Malaria.
Privy Leaflet.
Baby Leaflet.
Malaria and What Everybody
Should Know About It.
Disinfection After Diphtheria,
Measles, or Whooping Cough.
Disinfection After Scarlet Fever.
Health Helps for Teachers.
Fly Leaflet.
Typhoid Fever Leaflet.
Sanitary and Hygienic Care of
Prisoners.
Cancer Leaflet.
How to Nurse a Tuberculous
Patient.
Health Catechism.
Adenoids.
Tuberculosis.
Pellagra.
Smallpox.
MeasL's.
No. 74. Scarlet Fever.
No. 75. Baby Weliare.
No. 76. Save the Baby.
The Child.*
Teeth, Tonsils, and Adenoids.*
How to Live Long.*
Hookworm Disease.*
First .Aid in the Home.*
The Health of the Worker.*
Smallpox and Its Prevention.*
A War on Consumption.*
Milk.*
Some Facts About Scarlet Fever.*
A Few Facts -About Measles.*
Typhoid Fever and How to Prevent
It.*
How to Build a Sleeping Porch.*
Dental Lectures.!
Dental Hygiene.
t
Anti-Spitting Placards (5 inches by
7 inches).
Anti-Fly Placards (14 inches by 22
inches).
Anti-Typhoid Placards (14 inches
by 22 inches).
Anti - Tuberculosis Placards (14
inches by 22 inches).
*Furnished by courtesy of the Metropolitan Life Insurance Company.
tFurnished by courtesy of Colgate & Company.
EDWARDS i BROUGHTON PRINTINS CO . RALEIGH. N. C
Vol. XXXI MAY, 1916 No. 2
ASHEVILLE PUTS FIRST THINGS
FIKST
Gires Public Health First Place of Ini-portance
in Municipal GoYernment
I
FINE example of the thorougli-
^^ ness and efficiency of AsheviMe's
'^*' Health Department is her .jres-ent
campaign for the absolute elimina-tion
of the surface closet. At the
present time Asheville has only about
three hundred such closets. This num-ber
is being gradually reduced by the
laying of new sewers, and it will be
reduced to two hundred by June, and
by midsummer there will not remain
one such closet in Asheville. This is
being done through the ordinary finan-cial
channels, assessing the cost of
such new sewers against the property.
Asheville forces all property without
delay or discrimination to connect with
the sewers as soon as they are ready.
If for any reason the owner is not able
to install closets and connect with the
sewer, the city does this, charging it as
a lien against the property and per-mitting
the property owner to repay
in monthly installments. All surface
closets are cleaned weekly by the city.
No one can conduct the business of
washerwoman in the city of Asheville
without a permit from the Department
of Health. The homes of the washer-women
are inspected and graded.
Asheville has learned to place the
proper relative estimate upon her gov-ernmental
activities, and has had the
wisdom to recognize that the public
health is of the first importance. Ashe-ville
has also learned that the living
conditions of a city are of the first
consideration, and the position which
she occupies as the best governed city
in North Carolina is due largely to the
fact that her ideal of municipal gov-ernment
and progress is expressed in
terms of public health and social
soundness; physical well-being and
right living; a wholesome atmosphere,
physical and moral; a civic conscience,*
concerned with every part of the com-munity
life. In other words, Ashe-ville
puts first things first.—A. W. Mc-
Alister.
ANOTHER KNOCK-OUT
In former times whiskey was re-garded
as the only remedy for snake-bite
and a bad cold. As pneumonia
was commonly regarded as the out-crop
of a bad cold, whiskey was like-wise
regarded as the sovereign remedy
fo: .^.neumonia. But the doctors are
shelving liquor even for the treatment
of this more serious form of the bad
cold. The United States Public Health
Service is sending out bulletins in-tended
to safeguard the people in this
season of pneumonia, and the bulletin
contains information of a valuable
kind. A list of causes contributing to
pneumonia is given, and alcohol is
specified as one of the most important
contributing agencies. It is stated
that alcohol is indeed the handmaiden
of pneumonia and there is none more
sure or certain of success, especially
if liberally and continuously used. The
old snake-bite remedy is being knocked
out everywhere, and it is well that
North Carolina is even fairly weaned
from thoughts of it.—Charlotte Ob-server.
T ,'l , I , l,,.l .1,1
PUBLIC HEALTH
AND SANITATION
TEACHING HEALTH BY MOTION
PICTUKES
How Public Health is Being Taught in
Kural Districts by Means of Trar-eling
Motion Pictures
Wahrbn H. Booker, C.E.
Chief of the Bureau of Engineering and Education.
Yj] IRCUS day in the city is getting
^^ to be a scarcely more important
^^ event than Motion Picture
Health Day at the country cross-roads.
Yes, real genuine motion pictures. Not
stereopticon lantern slides nor magic
lantern pictures, nor a gas-lighted
lantern, but a fully equipped portable
motion picture machine of the very
latest type with a powerful electric
lighting plant which travels about
from place to place in a large auto-mobile
giving intensely interesting
presentations of the health problem
by means of motion pictures.
Yes, there are comic films, too. Just
as all work and no play is a bad thing,
so all health and no comic films would
not make a good program.
It usually takes about twenty to thir-ty
minutes after arriving at a school-house,
church, or hall to set the mo-tion
picture machine up, hang the cur-tain
or screen, and run the cable from
the electric lighting plant, which ordi-narily
remains stationary in the car,
through a door or window to the mo-tion
picture machine in the hall. When
an entertainment is given in the day-time,
it usually takes a few minutes
longer to darken the windows by
means of black curtains. In the eve-nings
in warm weather the entertain-ments
are frequently given out of doors
in the open air.
Special provisions are made for
lighting the schoolhouse, church, or
hall, as the case may be, by means of
strings of incandescent lights opera-ted
at will by the lecturer from the
switchboard of the machine.
Besides the regular motion pictures,
a Victrola is carried along to provide
a preliminary musical program while
the audience is gathering, as well as
to furnish appropriate music while the
comic films are running. While the
health films are on the screen, the
lecturer in charge delivers a running
lecture, as it were, at suitable times
and places throughout the pictures.
After each entertainment comes one
of the most valuable features of this
work, the distribution of free health
literature. During the entertainment
an exhibit of free health literature is
provided in the hallway or some con-venient
place nearby. After seeing
motion pictures dealing with typhoid
fever, tuberculosis, care of the teeth,
malaria, mosquitoes, flies, care and
feeding of babies, and other health
subjects, many persons in every audi-ence
become very much interested, and
want to learn still more about such
things. For such, and for such only,
is provided a limited quantity of free
health literature by this Board, to-gether
with other literature so gener-ously
provided for the occasion by the
Metropolitan Life Insurance Company
and the Colgate Company.
This outfit does not have to travel
out from cities and towns having ho-tels
as a base of supplies, nor do the
lecturer and machinist thrust them-selves
upon the charity, generosity, or
kindheartedness of the good people in
whose community they are working
THE HEALTH BULLETIN 21
for their board and room. Complete
camping, cooking, and sleeping out-fits
are carried along as a part of the
regular equipment. The accompany-ing
cut shows the outfit about to break
camp in the morning. The simple yet
strenuous outdoor life with plenty of
exercise and all its fresh air are ex-emplified
by these apostles of good
health by example no less than by
precept.
By means of the car, two places can
be visited a day, and motion picture
are used as announcements and occa-sionally
to supplement the teachings
of the health films. As a rule, a good
evening's entertainment is found to
consist of from five to six reels of
pictures, lasting from sixteen to twenty
minutes each. Ordinarily, a program
consists of a good scenic, comic, or
western film, followed by three health
films and concluded with a comedy.
The Board has a sufficient number of
films to give at least three complete
programs, and the usual plan is to go
IX CAMP
A complete camping outfit renders the lecturer and machinist independent of hotels and
boarding-hotises
health entertainments given at at least
twelve points a week. Occasionally in
large places these entertainments are
repeated one or more times at a place,
depending upon the population present
and the size of the hall. During the
country fair season the outfit is sup-plemented
with a large tent, seating
three hundred or more people, and a
continuous entertainment is carried
on as a free attraction of the fair dur-ing
the entire fair period.
Just a few lantern slides are used
in connection with the work, and these
to a county and give substantially the
same program at twelve different
places and then return to each of
these same twelve places one week
later with a complete change of pro-gram,
and again two weeks later with
another complete change of program.
No rental charge is made by this
Board for the use of the outfit. It is
loaned free of charge to any county in
the State having reasonably good
roads. For the present the only re-quirements
to secure a three-weeks
health campaign in a county are, first.
22 THE HEALTH BULLETIN
to providt at least $90 to pay for the
first week's operating expenses, so
that the first series of health enter-tainments
can be given free, and, sec-ond,
to select twelve or more advan-tageously
located points where such
motion picture health entertainments
can be given, and, third, to cooperate
with this Board in a thorough prelimi-nary
advertising campaign throughout
the county.
either by subscription or otherwise,
making admission to the entertain-ments
free, or they may charge an
admission fee. This Board discour-ages
the admission fee idea, and en-courages
counties and communities to
make these entertainments free to the
public wherever possible, for two rea-sons:
first, because by charging even
a small admission fee a certain class
of people will remain away, and as a
ENJOYING THE "HEALTH MOVIES"
Part of the audience at a typical Motion Picture Health Entertainment
In regard to providing the opera-ting
expenses for the second and third
weeks, this is usually done in one of
two different ways. First, instead of
providing only $90 for one week, as
many weeks may be provided for at
that rate as may be desired; or, sec-ond,
the various communities in which
the first week's entertainments are
given may be counted upon to provide
their share of the necessary operating
expenses for the return engagements.
rule this is the very class of people
that need such instruction most; and,
in the second place,, by charging an
admission fee more money is taken
away from the community than is
asked for.
In any county where provision is
made to meet only the first week's
operating expenses, this Board will
be perfectly willing to assume the re-sponsibility
for carrying on the work
during the second and third weeks.
THE HEALTH BULLETIN 23
The quality of these entertainments
has invariably been found to be such
as to commend them sufficiently to
cause those seeing the first entertain-ment
to ask that it return again and
again.
In regard to providing the necessary
operating expenses of $90 for the first
week to secure the outfit, this may be
done in any one of a number of ways.
It has been done in one county by a
single philanthropic individual, in an-other
by one man armed with a sub-scription
list; in another by the county
board of education, and in another by
the county board of commissioners.
Where any or all of these methods
fail, ingenious public-minded persons
will doubtless work out other methods
of securing the necessary $90 for the
first week's work, after which, if it is
desired, this Board will be responsible
for the second and third week's cam-paign.
This Board will be glad to answer
by correspondence any questions in re-gard
to further details of this work.
HOOKWOEM DISEASE
Its Cause, Core, and Prevention
OOKWORM is one of the most
common diseases in North Caro-
'^" lina. Ordinarily it does not man-ifest
itself in any startling or spectacu-lar
manner, like smallpox or toothache,
but gradually reduces the strength, vi-tality,
and efficiency of the unsuspect-ing
victim and makes him subject to
many other more serious ailments and
diseases. Its victims are usually chil-dren
and young people. It is estimated
that about one-third of our school chil-dren
and about one-fifth of our adults
are afflicted with this disease. The
reason for this difference is that chil-dren
more than older people as a rule
go barefooted in summer, and it is by
going barefooted more than any other
way that hookworm disease is con-tracted.
Hookworms are tiny, round, intes-tinal
worms about a half an inch in
length and about the size of an ordi-nary
No. 30 or No. 40 cotton sewing
thread. These little worms have
hooked or bill-shaped mouths by means
of which they hook or attach them-selves
to the inside of the intestines,
hence the name, hookworms. In this
position they suck blood from the in-testines,
cause them to bleed, and in-ject
small amounts of poison into the
sores or wounds they make. While
thus attached to the intestines the fe-male
hookworms deposit large num-bers
of tiny eggs. These eggs are so
sma 1 that they '^an be seen only with
a microscope. They do not hatch in
the intestines, but are carried on out
of the body and deposited with the
fecal matter at every bowel movement
of the victim. Under proper conditions
of heat, moisture, and air these hook-worm
eggs hatch out into tiny mag-gots.
Now, should a barefoot person
soil his foot with some of this fecal
matter or nearby polluted soil, these
tiny worms would at once begin to
burrow into the skin and set up what
is commonly known as "ground-itch"
or "dew-itch." Once these tiny hook-worms
get into the skin they are taken
up by the blood and finally find their
way to the intestines. Here they at-tach
themselves to the walls of the
intestines like their parents and begin
sucking blood and developing into
adult hookworms. In about two months
after the case of "ground-itch" or
"dew-itch" the infected person begins
passing hookworm eggs with every
bowel movement.
Country schools without sanitary
privies are probably the most common
sources for the spread of hookworm
disease. At such schools the boys are
usually required to retire to the woods
in one direction from the schoolhouse
and the girls in another. By such
means one hookworm infected family
may very readily expose the entire
school to infection.
24 THE HEALTH BULLETIN
The Damage From Hookworm Disease
The damage done by hookworm dis-ease
depends upon the severity and
frequency of the infection, A slight
infection decreases the victim's
strength and vitality only slightly. A
heavy infection or repeated infections
do a much greater harm. People thus
infected cannot keep up with their
companions either in work or in play,
and are frequently abused and ridi-culed
and called "lazy," when they are
simply exhausted because hookworms
are sapping their strength. Such peo-ple
deserve sympathy and help instead
of ridicule.
People whose strength and vitality
are lowered for whatever reason are
more disposed to contract other dis-eases,
such as colds, pneumonia, tuber-culosis,
typhoid, and others. While
hookworms rarely kill people directly,
they so weaken them that other dis-eases
which a healthy person would
ordinarily ward off prove fatal to the
hookworm victim.
In the case of little children, hook-worms
frequently stunt their growth
so that they are unable to keep up
with their school work. Finally they
become so languid and discouraged
that they give up school work in
despair.
How to Recognize Hookworm Disease
Besides the characteristic symptoms
and effects of hookworms already de-scribed,
the disease is usually recog-nizable
to physicians or laymen by the
anemic, pale, run-down condition and
bloodless appearance of the victim,
particularly if he admits having had
"ground-itch" or "dew-itch" within the
past few years or has been in the habit
of going barefooted during the summer
time. In other cases, slow-healing
ulcers persist; the hair is dry and
scant, especially the beard and that
in the arm-pits; the face and ankles
are often swollen, and the abdomen is
prominent, giving rise to the term
"pot-belly." In severe cases the ap-petite
may often be perverted and the
victim will eat coffee grounds, soot,
clay, etc., hence the term "dirt-eaters."
The presence of hookworm disease
may be definitely known by sending a
specimen of the morning bowel action
to the county health officer or to the
State Laboratory of Hygiene at Ra-leigh,
where a microscopic examination
for hookworm eggs will be made, free
of charge, provided that the specimen
is properly marked with the patient's
name and sent in a tight tin box. An-other
way of diagnozing the disease is
to take the simple treatment described
below and look for the hookworms
which, if present, may be found by
carefully washing and straining the re-sulting
bowel action through cheese
cloth.
Hookworm Disease is Easy to Prevent
In order to prevent hookworm dis-ease
everybody should wear shoes the
year round. Everybody should use
sewers or sanitary privies, which
would not only protect against hook-worm
disease, but also against typhoid,
cholera, dysentery, and summer com-plaint
among babies; and every person
infected with hookworms should take
the treatment for the disease.
A Good Privy
Of course the best thing for the in-dividual
who has hookworm disease is
to be cured—the sooner the better-and
the best thing for those who wish
to guard against the disease is to wear
shoes, but the most far-reaching gen-eral
health precaution is to build good
privies.
Perhaps the simplest and best type
of privy for the money is the so-called
"pit type." It consists of a substan-tial
fly-proof privy weatherboarded
tight down to the sills all around, and
is set over a small pit or hole in the
ground. This pit should be from two
to four or five feet deep by two or three
feet square. Almost any convenient
size or shape of pit that can be covered
by the privy will do. Special care
THE HEALTH BULLETIN 25
should be taken to see that the privy
sits down close all around and, as a
further precaution, earth should be
banked up around the edge of the privy
so as to make it absolutely dark and
fly proof. A flap door should fit down
over the hole in the seat. In the
course of a few years, if the pit is
found to be filling up, a new pit should
be dug near by and the privy moved
over it, using the earth from the new
pit to fill up the old pit and to bank
PIT PRIVY
A good, cheap type of privy for rural use. Note
it is will huilt close down to the ground all round,
which excludes flies from the pit. The pit may be
2 or 3 feet square by 3 or 4 feet deep.
around the lower edges of the privy.
Such privies should be located at least
one hundred yards from any well or
spring and on lower ground, so that
the drainage is in no case toward a
well or spring.
Hookworm Disease Easily Cured
Besides being easily prevented, hook-worm
disease is also easily cured. The
treatment is usually given as follows:
Eat little or no supper in the evening
and take a good dose of Epsom salts
before retiring. As soon as the bow-els
have acted in the morning, take
half the quantity of powdered thymol
prescribed with a little water, and lie
on the right side for half an hour to
allow the thymol to quickly pass out
of the stomach into the intestines.
Two hours later take the remainder of
the thymol and again lie on the right
side. This thymol will cause the hook-worms
to loosen their hold on the in-testines.
Two hours after taking the
second half of the thymol, take an-other
dose of Epsom salts together
with a cup of hot, strong coffee with-out
sugar or cream. This will expel
the hookworms and the thymol re-maining
in the intestines.
In the majority of cases two treat-ments
like the above, taken a week
apart, are necessary to expel all the
worms. The total amount of thymol
given at a treatment should depend
upon the size and weight of the pa-tient.
In general, about one grain is
given for every three pounds of weight
of the patient. Thus, a sixty-pound pa-tient
w^ould be given twenty grains in
two doses of ten grains each. Special
care should be taken by the patient not
to eat or drink any alcoholic drinks,
patent medicines containing alcohol,
gravy, butter, milk, fat or oily foods
during the day of the treatment and
the day before, as such substances are
dangerous in combination with thymol.
WHY IS A TONSIL?
Modern medical science has proved
that the tonsils are the cause of many
grave disorders. When diseased they
may cause not only bad breath, sore
throat and deafness, but many serious
affections commonly known as rheu-matism,
neuralgia, pleurisy, infection
of the lungs, tuberculosis, appendicitis,
ulcer of the stomach, heart disease,
kidney affections. These throat glands
are the frequent open doors to germ
invasions whose poisons may pro-duce
hardening of the arteries. Better
slaughter a hundred innocent-looking
tonsils than run the risk of sickness
and premature death by harboring one
that is guilty.
SPITTIJVG UNNECESSARY
Spitting is a thoroughly unnatural
performance and indicates an abnor-mal
condition. No animal spits, save
rarely to defend itself against or show
its disgust for an enemy, and it is,
therefore, a most undeserved libel upon
the animal creation to call a man a
beast for expectorating.
Saliva is valuable—so valuable, in
fact, that it cannot be bought for love
or money, as a product of any labora-tory
in the land. Besides, its use in
digestion (if we take time to make use
of it), serves as a constant cleanser
of the mouth, and if we lived health-fully
otherwise, would serve to keep
our teeth in perfect condition. The
body never produces it in wasteful
amount save to counteract and wash
away some harmful substance intro-duced
into the mouth.
The most frequent cause of irrita-tion
to the mouth and throat, and
therefore the most frequent cause of
spitting, is tobacco. Chewing of the
weed is a little out of fashion at pres-ent,
and there is less expectoration in
consequence, but the smoke from to-bacco
is also an irritant, and an over-production
of saliva follows in Nature's
effort to soothe and cleanse the delicate
tissues. From its constant use a
chronic irritation of the throat is also
produced, accompanied by an overse-cretion
of mucus to protect the injured
surfaces. We must either swallow
this excess or discharge it from the
mouth.
The spitting which accompanies a
cough may be a more serious matter
for all concerned. The material coughed
up should never be swallowed, and ex-pectoration
is, therefore, unavoidable
for the welfare of the cougher. For
the welfare of others it is necessary
that the sputum should be deposited
in a receptacle which can be burned.
—
James F. Rogers, M.D., in Physical
Culture.
GUARD TOUR HEALTH BY WATCH-ING
YOUR KIDNEYS
Over 600,000 people in the United
Stattvj die annually from preventable
diseases through ignorance or neglect
of ordinary precautionary measures.
This is due in a very large measure
to the sedentary life led by such a large
proportion of our business men. They
overexercise their brain, underexercise
their bodies—eat and drink too often
and too much—burn the candle at both
ends, and in many needless ways bend
and break the laws of health, the ob-servance
of which would prolong and
make profitable the lives of a vast army
which man pushes on to destruction.
In this day of advanced scientific
medical knowledge and research, it is
possible for one to keep close tab on
one's physical condition, and the wise
and prudent man (or woman) will now
at fairly regular and not infrequent
intervals submit himself for a physical
examination or arrange for some satis-factory
inspection that will evidence
the normal and abnormal status of his
THE HEALTH BULLETIN 27
physical machine, and not wait until
an evident loss of energy and vitality
warns him that some one of his vital
organs is not doing its worli thorough-ly
and well.
Dr. G. A. DeSanto's Saxe, a leading
authority, says: "The urine offers the
greatest possibility for an insight into
the workings of the human system."
Dr. Purdy, another high authority,
says: "Through urinalysis alone can
an almost daily increasing number of
diseases be determined, their intensity
be gauged, their progress towards re-covery
or tendency towards a fatal
termination be predicted. No serious
disease can be in progress without
giving rise to more or less marked
changes in the character of the urine."
Dr. Lukins says: "The condition of
the urine reflects the health or ill
health to a greater extent than any
other organ in the body."
Dr. William A. Evans, former Health
Commissioner of Chicago, than whom
there is no greater authority on pre-ventive
medicine, says: "In my judg-ment,
the plan of periodic examinations
of the urine will prove of great value."
Diabetes, Bright's disease and its
many complications, such as hardening
of the arteries, uremia, various heart
diseases and diseases of the bladder,
are first usually detected by system-atic
and periodic analyses of the urine.
According to the United States
census report, there are over 130,000
deaths in this country annually from
diabetes and Bright's disease alone,
and all authorities agree that a great
majority of these could be prevented or
postponed for years if the impairment
were detected in time—that is, in their
early stages.
Most forms of kidney diseases can
be cured if recognized and treated in
their early stages.
No period of life renders one im-mune
from diabetes or Bright's dis-ease.
Bright's disease, especially, yields
readily to treatment if discovered in
its earlier stages. A thorough and
complete microscopical and chemical
analysis of the urine—and this only-will
determine positively either the ex-istence
or nonexistence of this dread
disease.
The wise man of the future will re-cognize
the wisdom of keeping correct
tab on his physical as well as finan-cial
condition. He will recognize the
fallacy and danger of drifting along in
fancied security and will at regular
and stated times take stock of his phys-ical
resources.
"MAKE HEALTH CATCHING"
It was said by Ingersoll that he
could have made a better world than
this by making health catching instead
of disease. If we learn to obey hygien-ic
laws there will be no catching dis-eases,
and health will spread and pre-vail
everywhere. This world was
meant to be better than it is, and it is
only our ignorance, indolence and per-versity
that prevent it.
While no means of improvement
should be neglected, the largest and
surest returns will be secured by
dealing with the children. Teach
them hygiene and sanitation from in-fancy
up. Inhibit child labor every-where
and enforce the law. Let there
be medical inspection of the schools,
securing ventilation and providing for
the correction of malformations, bad
teeth, defective eyesight and for regu-lar
physical training. Insist on an ad-equate
playground for every school-house,
and for the best, most useful
development of the child, both intel-lectual
and physical, combine manual
and mental training. With these meth-ods
universally carried out for a gene-ration
many present-day problems will
vanish.—Cincinnati Enquirer.
The death rate among children under
five years old, if allowed to prevail
among hogs and cattle would finan-cialy
ruin the breeder.
28 THE HEALTH BULLETIN
THE PACE THAT KILLS
Eational Living Eeconimended as a
Medicine Worth Trying
^7=T|0CT0RS have told us often in late
_ years that our pace is too fast
—
'^™ that we are living not wisely but
too well. Insurance companies, from
motives that are entirely obvious, are
urging reform; lately they have united
in an effort to find out precisely what
is wrong with our manner of living
and to provide a remedy.
To that end, the Life Extension Bu-reau
of New York, through Dr. Ly-man
Pisk, medical director, has been
making an investigation. A group of
1,000 skilled mechanics was examined
and later another group of 1,000 clerks.
The object, of course, was to compare
the health of men who live active
lives with the general health of men
whose business is of sedentary char-acter.
It was found, according to word
from the Doctor, that the mechanics,
as a whole, were little, if any, better
off than the clerks. The active work-ers
presented fewer cases of heart dis-ease,
but more cases of thickened ar-teries.
Bad blood pressure was slightly
more prevalent among the clerks than
among the factory employees, but the
latter showed twice as many cases of
kidney trouble as the former. They
had more lung impairment, too. More
than half the members of the groups
were partaking daily of unsuitable
diet. Doctor Fisk says further about
the results:
"I feel justified in asserting that the
evidence of widespread premature
physical decay, which is suggested by
our vital statistics, is to a considera-ble
degree confirmed by actual exami-nation
of large groups of supposedly
healthy young people. Thousands of
people are slowly and inevitably pre-paring
for physical breakdown or pre-mature
death, and there can be no
more important work for modern med-icine
than to bring such cases, as early
as possible under proper hygienic or
medical guidance."
And, he adds, "That there is some
particular influence at work causing
the upward trend in mortality from
organic diseases, seems probable. It
may be found in our rapid industrial
and social evolution, bringing about a
condition of widespread prosperity and
lavish expenditure—this relatively ex-tending
to the comparatively small
wage-earner in the factory."
This is not saying much that is help-ful.
It is too vague to be of apprecia-ble
service. But it does prescribe
simpler and more rational living, and
that surely is a medicine worth try-ing.—
The Dodge Idea.
The United States is at the present
time spending more than thirty-three
million dollars yearly for the cure and
care of patients afflicted with mental
disease, and comparatively nothing for
prevention. And yet the perusal of
the report of almost any state hospital
will show that in about 50 per cent of
the cases admitted the mental disorder
is due directly to definite causes which
are clearly preventable. From 5 to 10
per cent more are functional disorders
which probably could have been pre-vented
by early treatment.—Eva Char-lotte
Reid, M. D., After-Care Physician
for California State Hospital.
In the entire realm of preventive
medicine, there is no factor more po-tent
than early diagnosis, first, because
disease is far more amenable to treat-ment
in the early stages, and second,
because early diagnosis affords greater
advantages in preventing the spread ol
infection to others.
Spasmodic cleanliness is better than
no cleanliness at all. But it is cleanli-ness
all the time that makes most for
health, happiness, and freedom from
disease.
THE HEALTH BULLETIN 29
IT COSTS LITTLE TO LIVE A
HEALTHY LIFE
Some people think they cannot live
healthy lives unless they are rich.
This is wrong. It is true that rich
people can do some things for their
health that others cannot, but many
rich people live unhealthy lives be-cause
they buy things which are not
good for them. You may not be able
to have the kind of house you would
like to live in. You may not be able
to work in the factory or store you
would like. You may not be able to
do the kind of work you would like
best, but you CAN make all these
things healthier.
You can keep more windows open in
your home; you can often get the
"boss" to keep more windows open in
the factory or store; you may be able
to move further out of the city where
it costs no more to live; you may be
able to get another job.
Even if you cannot do these things,
you can do others that cost nothing.
It costs you nothing to have your win-dows
open while you sleep. It costs
you nothing to take breathing exer-cises
or to stand, sit and walk erect.
It costs you nothing to have your bow-els
move thoroughly and often.
Almost all of us can take enough
time to eat our meals slowly. The
foods that make us most healthy are
often the cheapest foods. Expensive
foods like meats are apt to be less
healthful.
Remember that we can enjoy cheap
food and grow healthy from eat-ing
it. Here is the list of foods in
which the cheapest are given first and
the dearest last: Glucose, corn meal,
wheat flour, oatmeal, sugar, salt pork,
rice, wheat bread, oleomargarine,
beans, peas, potatoes, butter, milk,
cheese, beef stew, ham, mutton chops,
beef, eggs, oysters.—Irving Fisher.
Keep up the fresh-air habit and the
cold bath this winter.
WHEN PEKUNA WAS AT ITS BEST
Illustrating how a person may very
innocently become an alcohol addict,
the editor of one of our medical jour-nals
tells the following:
One of the most serious cases of
hob-nail liver that the writer has ever
seen was a victim of Peruna in the
days when Peruna contained at least
40 per cent of alcohol; the case was
that of a woman—a temperance worker
of considerable prominence. She had
taken Peruna for a number of years,
in ever increasing doses; she was a
chronic alcoholic; but due to her work
for temperance, her symptoms were
wholly misunderstood by her family
and friends. She finally died of chronic
alcoholism, yet no drop of alcoholic
beverage, with the exception of Peru-na,
ever passed her lips. Post-mortem
examination revealed the real cause
of her death which had been obscure
and which had puzzled the medical
staff of one of the largest hospitals, in
which she spent the last few days of
her life. This was a plain case of ig-norance
which led to the patent medi-cine
habit being established in the first
place and continued to the end.—Ex-change.
TAXES AND TANGLEFOOT
The cattle ticks have been eradi-cated
in Edgecombe, and I understand
the National and State governments
are at our service if a hog has cholera.
Is not the health of the average citi-zen
of the town and county of as much
value as a "bull yearling" or a razor-back
shoat? Why not get a health offi-cer
who is an expert on sanitation?
Give him authority and let him be
such a man as will enforce his regula-tions.
If every person in Edgecombe
was taxed ten cents—hang expense,
make it a quarter—such a person, with
an assistant, could be procured. I
have paid already my quota for many
years in "tanglefoot."—A Writer in
Tarboro Southerner.
fllLDjlYGIENE
FOR THE MENTAL HEALTH OF
CHILDREN
The following brief suggestions are
regarded by experts as among those
essential in promoting the mental
health of children.
Give your child opportunity for a
variety of wholesome activities and
interests.
Train your child to work hard in
some regular occupation suited to his
ability and talents; but to avoid fa-tigue
by alternation of work and rest.
Train your child to give attention to
the present situation.
Train your child to strict obedience
In a few important matters and let
him alone in regard to the unimportant
things.
Avoid conditions that tend to pro-duce
overstrain or precocity. The
special business of a young child is to
grow and to play with other children.
Give your child a variety of well
cooked, wholesome food in ample quan-tity
at regular intervals.
Train your child to healthful habits
of sleep in fresh air, giving opportu-nity
for at least nine hours, and for
more than that before the age of
twelve.
If your child becomes worried or
sleepless, or has muscular twitchings
or the like, consult a competent phy-sician
at once.
Take advice of a competent person
concerning the peculiar, sensitive, or
nervous child, in order to correct a
possibly bad inheritance by proper ed-ucation
and environment.
The best method of training is by
example.
INFANT MORTALITY
There are two thousand North Caro-lina
babies—one out of every five born
in the State—that die annually under
one year of age. This is lamentable.
And some of this mortality is due to
conditions that should be bettered
rather than to a merciful Providence
who is often incorrectly, though sub-missively,
credited with the untimely
death of the little ones. Undoubtedly
there is many a Rachel among us,
weeping for her children, whose arms
should never have been robbed and
whose tears should never have been
shed.—Biblical Recorder.
"BABY" JONES
"I want my given name on the cer-tified
copy of my birth record, not
'Baby,' " wrote an indignant young
lady who lived out of town and ^vho
had sent fifty cents for a certified copy
of her birth certificate which she re-turned
with her letter.
She was informed that the certifi-cate
mailed her was an exact copy of
the original on file in the Bureau of
Vital Statistics, in which she was des-ignated
as "Baby" Jones. As she
has grown to womanhood she natu-rally
desired to substitute her real
name for "Baby." Very much depend-ed
upon this in the young lady's inter-est,
which cannot now be corrected.
Fortunately, this condition has
changed. Doctors and midwives, as
well as parents, have learned to ap-preciate
the importance of putting the
full name of the infant on the original
birth certificate, but occasionally we
still get certificates without the given
name. In case of twins this is espe-
THE HEALTH BULLETIN 31
cially important as to which is first
born, and the only way this can be
decided is by the given name.
Few people recognize the importance
of complete birth certificates, and un-fortunately
those who must suffer as
a result of such inaccurate certificates
are the infants, after they have grown
to adult life. With death certificates
it sometimes happens that the de-ceased
was the only person who could
have given certain required data; but
there is absolutely no excuse for any
missing data on birth certificates.
—
Buffalo Sanitary Bulletin.
MEDICAL I\SPECTIO?f OF SCHOOLS
Medical inspection of schools is a
new project in North Carolina. It has
been taken up by a few of the counties
as an experiment and has proven such
a success that funds have been appro-priated
for the continuance of the
work. Too much importance cannot
be laid upon the benefits that this
work can produce. It is a vital mat-ter
to every community to see that
its school children are in good health.
Under the plan of work which Ala-mance
and Northampton counties have
adopted, inspection of the schools is
made at regular periods and advice
given wherever needed. In this way
each child is kept in good health and
the danger from any epidemic of dis-ease
is practically eliminated.—Wash-ington
News.
DRINK MORE WATER
It is a sad reflection upon human na-ture
that the hard-attained is most
appreciated and pursued. "I send you
to a spring across the street," said a
German physician to an American
whom he had recommended to a water
resort back in America near the lat-ter's
home, "and you drink, maybe,
one pitcherful. I send you six thous-and
miles and—what? You drink it
in tubs!"
A FOOL'S PARADISE
Every year millions of dollars are
spent by the American public for use-less
and often harmful medicines. So
many people who would never im-agine
themselves capable of repairing
an intricate piece of machinery will
undertake to repair the most intricate
machine of all—the human body.
When you are ill—even though your
illness may seem slight—see your doc-tor.
Don't buy a supply of pills or
powders with the idea that they'll cure
you. It is an old saying among law-yers
that the man who tries to attend
to his own case in court has a fool
for a client. That being true, what
could in justice be said of the man who
tries to be his own doctor when he is
sick?
TOUR CHILD'S BIRTHRIGHT
The official registration of its birth,
showing parentage and when and
where born, is the right of every child.
The new born babe being helpless in
the matter, most communities have
placed the duty and responsibility of
the registration of the birth upon the
attending physician or midwife. Under
the circumstances, no physician or
midwife has performed his whole duty
to either of his patients, the child or
the mother, until a properly com-pleted
birth certificate has been regis-tered.
In fact, so great may be the
importance to the child in after years
of having its birth registered that a
physician who neglects his patient's
interests to such a degree as to fail to
register a birth might in all justice be
considered an improper person to hold
a license to practice medicine. Very
probably, as parents grow to appreci-ate
the importance of the registration
of their children's births, the failure
of the attending physician or midwife
to register the required certificates
may become a not uncommon cause of
suits at law for damages.—U. S. Public
Health Service.
32 THE HEALTH BULLETIN
FEESH AIR AND WHY
a^
Let's Have a Little More in Our
Schools and Homes
N unstinted supply of fresh air
in the schoolroom will help get
higher grades, prevent more
failures in class work, more cases of
head .che, colds, sniffles, grippe, and
contagious diseases, keep better order,
and yield the teacher, school board,
and taxpayers greater returns in every
way for the money and energy ex-pended
than any other investment they
BEFORE AND AFTER
TAKING FRESH AIR
than in winter. Disease material dis-charged
from the mouth and nose of
those already affected is quickly scat-tered
and blown away, while, on the
other hand, this same abundance of
fresh air increases our vitality and
ability to resist such diseases. As
soon as we begin to huddle together in
the fall and close down our windows,
up goes the sickness rate. This is
largely because we confine ourselves
in air-tight houses, schools, churches,
and offices. Here we breathe in, in a
more concentrated form, the infection
WANTED—More fresh air in the
curriculum.
can make. Fresh air in abundance
serves the double purpose, first, of
rapidly diluting and carrying off dis-ease
particles coughed up and sneezed
and spit out, and, second, of greatly
building up the individual's physical
vitality or resistance so that he can
successfully ward off attacks of the
above mentioned ailments.
Practically everybody knows that
we have fewer cases of colds, measles,
scarlet fever, diphtheria, whooping-cough,
smallpox, and pneumonia in the
summer-time than we do in the win-ter.
One of the chief reasons for this
is that we indulge in more fresh air
and live out of doors more in summer
WANTED—Mure Nurih Carolina
schouls like this.
given off by others; we swap infec-tions,
as it were, and with reduced
vitality we soon become victims of
colds and other ailments.
Perhaps the best way to admit fresh
air through the window is to place a
board or piece of framed glass from
6 inches to a foot in width and as
long as the window is wide across
the bottom of the window in an in-clined
position, so that when the win-dow
is raised from 5 to 10 inches the
incoming fresh air will strike this
inclined board or glass and be de-flected
upward. This effectually pre-vents
any objectionable drafts.
[VI n
TARPOPOi N. C.
Published bij T/\L/4°RmG\R9LI/iA STATE. B^ARD s^AE^Un
This Bullelin will be asrxt free to arvj atizerx of the 5tcrteupoi\rec[ue5t|
Entered as second-class matter at Postoffice at Raleigh, N. C, under Act of July 16, 1894.
Published monthly at the office of the Secretary of the Board, Raleigh, N. C.
Vol. XXXI JUNE, 1916 No. 3
The Newspapers and Public Health
The Doctors and the Newspapers to Clear the
State of Preventable Diseases
"The doctors and the papers! The health and happiness
of the people of a great State are largely in their keeping.
' Together let us beat this ample field.' Combining their efforts
to a common end—the education of the people in the sane
and safe rules of good health, and to the importance thereof
—
they could in the course of time rid the State of all preventa-ble
diseases. There should be no reason why we could not
have a State clear of disease of a preventable nature. But we
should not be content to stop there. The newspapers and the
physicians should set the higher mark of giving North Caro-lina
the finest health record of any State in the Union. With
the doctors leading the way and the papers urging the people
to follow on, our State might easily be placed at the head of
the list."
—
From an address by Mr. Wade H. Harris, editor of
the Charlotte Observer, at Durham, April 19, 1916.
TABLE OF CONTENTS
The Newspapers and Public Health 33
Editorial 35
For County Hospitals 35
The School Nurse 36
An Open Letter 37
Health and Morals 37
Health Officers Put Ban on Drink 37
The Newspaper and the Public Health 38
Tuberculosis Department 40
Why Doctors Should Report Tuberculosis 40
Contagionand Ignorance.. 42
Will It Pay to Look After Our Health? 42
Personal Hygiene 43
Colds. 43
Malaria and What to Do About It 46
Cancer on the Increase 47
Keeping in Repair (with cartoom 48
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
J. Howell Wat, M.D., Pres., Waynesville
Richard H. Lewis, M.D., LL.D., Raleigh
J. L. Ludlow, C.E., . . Winston- Salem
W. O. Spencer, M.D., . . Winston-Salem
Chas. O'H. Laughinghouse, M.D.,
Greenville
Edward J. Wood, M.D., . . Wilmington
Cyrus Thompson, M.D., . . Jacksonville
Thomas E. Anderson, M.D., . Statesville F. R. Harris, M.D., . . . Henderson
Official Staff
W. S. Rankin, M.D., Secretary of the State Board of Health and State Health Officer.
C. A. Shore, M.D.. Director of the State Laboratory of Hygiene.
Warren H. Booker, C.E., Chief of the Bureau of Engineering and Education.
L. B. McBrater, M.D., Superintendent of the State Sanatorium.
J. R. Gordon, M.D., Deputy State Registrar.
G. M. Cooper, M.D., Chief of the Bureau of Rural Sanitation.
Miss Mary Robinson, Chief of the Bureau of Accounting.
FREE PUBLIC HEALTH LITERATURE
The State Board of Health has a limited quantity of health literature on the subects
listed below, which will be sent out, free of charge, to any citizen of the State as long as
the supply lasts. If you care for any of this literature, or want some sent to a friend, just
write to the State Board of Health, at Raleigh. A postcard will bring it by return mail.
Scarlet Fever.
Baby Welfare.
Save the Baby.
The Child.*
Teeth, Tonsils, and Adenoids.'
How to Live Long.'
Hookworm Disease.*
First Aid in the Home.*
The Health of the Worker.*
Smallpox and Its Prevention.*
A War on Consumption.*
Milk.'
Some Facts About Scarlet Fever.*
A Few Facts About Measles.*
Typhoid Fever and How to Prevent
It.*
How to Build a Sleeping Porch.*
Dental Lectures, t
Dental Hygiene, f .
Anti-Spitting Placards (5 inches by
7 inches).
Anti-Fly Placards (14 inches by 22
inches).
Anti-Typhoid Placards (14 inches
by 22 inches).
Anti - Tuberculosis Placards (14
inches by 22 inches).
* Furnished by courtesy of the Metropolitan Life Insurance Company.
t Furnished by courtesy of Colgate & Company.
No. 12.
D)W
I PUBU5ME.D Sr TML nPR.TA CAJouMA 5TATL BQMgP °XMEALTa1
Vol. XXXI JUNE, 1916 No. 3
EDITORIAL
FOE COUNTY HOSPITALS
Resolntion Urging County Hospitals
for Every County in the State
j^IHE accompanying resolution was
J^ presented by Dr. J. Howell Way,
^'^ President of the State Board of
Health, and unanimously adopted by
the State Health Officers' Association
at their recent meeting in Durham.
In presenting this resolution Dr. Way
said in part:
In our judgment as public health
workers in North Carolina, the time
Often their construction has saddled
finaiicial obligations upon medical men
from which they never ceased to be
burdened with, all because of a certain
pride of profession, or at times a sense
of possible duty, that impelled them
to take the initiative in providing for
the community facilities for the care
of the sick, which duty is a community
duty, and not a duty of the medical
profession as individuals.
There is no more justice in assum-ing
that physicians should erect and
pay for the maintenance of a com-munity
hospital than there exists jus-tice
in the suggestion that lawyers
should build the jails and courthouses,
o. ministers of religion erect the
Resolyed, by the North Carolina State Health Officers' Association, That
in the judgment of this body the time has now arrived for the individual
counties of the State lo provide for the erection and maintenance of local
county hospitals for the care and treatment of the sick as a necessary and
vital part of a proper and advanced health policy.
is now ripe for the separate counties
to provide proper care for their sick
and afflicted as a necessary public
health measure. We believe the sick
of a community should have at least
as much attention as is given the crim-inal
classes! Witness the comfortable
jails built to house our malefactors,
and the luxuriously appointed court-houses
erected in which to try ^ these
same malefactors. Are not the sick
worthy of equal consideration? It has
been said in the past that we were a
poor people and could not afford local
county or community hospitals. If
this was ever true, it is not true now.
By far the large majority of local hos-pitals
in North Carolina for the care
of sick people have been built by phy-sicians
from their limited funds.
churches for the use of the other peo-ple
of a community.
A proper appreciation of the advan-tages
of a modern hospital is one of
the evidences of advanced civilization,
and with this appreciation properly
should also come the disposition on
the part of local communities to make
provision for the care of their sick.
The county is the unit of our govern-mental
system, and the counties should
feel it as much incumbent on them to
make proper provision for the care of
those afflicted in body, as well as for
those whose moral natures are at-tuned
at variance with the established
moral thought of the community. In
other words, let us put it up to the
average county of our great State, that
if the county is financially able to
36 THE HEALTH BULLETIN
spend public funds to provide for the
criminal classes of society, there exists
at least an equally strong if not great-er
series of reasons why those physi-cally
unfit should be cared for. Take
the school inspection work going on
all over the State as an example of the
need of local hospitals. Let the in-spector
note the imperfections of a
given number of children. How many
of them are financially able to go to
some distant city where proper facili-ties
for the operative care of many
such patients are to be had? Once
have a local hospital, and there in-evitably
develops from among the lo-cal
profession men capable, willing,
and anxious to perform the needful
operations for which many people of
our State yet go to distant cities where
ample hospital facilities are to be had.
This costs more money to our citizens
and retards the development of the
local medical profession.
But this is not all. The large ma-jority
of the patients needing surgical
treatment never get such benefits un-less
there is a community hospital.
Are not the boys and girls, the men
and the women of this grand old State
worth the investment of sufficient
county funds to erect and maintain in
every county in North Carolina a com-munity
hospital? We will never be a
fully civilized people until this is done,
and now is the time to make a start
in thus bettering the physical condition
of our people.
THE SCHOOL NURSE
The value of the school nurse is one
feature of medical inspection of schools
about which there is no division of
opinion. Her services have abun-abundantly
demonstrated their utility,
and her employment has quite passed
the experimental stage. The introduc-tion
of the trained nurse into the ser-vice
of education has been rapid, and
few school innovations have met with
such widespread support and enthusi-astic
approval.
The r,eason for this is that the school
nurse supplies the motive force which
makes medical inspection effective.
The school physician's discoveiT of de-fects
and diseases is of little use if the
result is only the entering of the fact on
the record card or the exclusion of the
child from school. The notice sent to
parents telling of the child's condi-tion
and advising that the family phy-sician
be consulted, represents wasted
efloTt if the parents fail to realize the
import of the notification or if there
be no family physician to consult. If
the physical examination has for its
only result the entering of words upon
record cards, then pediculosis and tu-berculosis
are of precisely equal im-portance.
The nurse avoids such in-effective
lost motions by converting
them into efficient functioning through
assisting the physician in his exami-nations,
personally following up the
cases to insure remedial action, and
educating teachers, children, and pa-rents
in practical applied hygiene.
To sum up the case for the school
nurse: She i^ the teacher of the pa-rents,
the pupils, the teachers, and the
family in applied practical hygiene.
Her work prevents loss of time on the
part of the pupils and vastly reduces
the number of exclusions for conta-gious
diseases. She cures minor ail-ments
in the school and clinic and
furnishes efficient aid in emergencies.
She gives practical demonstrations in
the home of required treatments, often
discovering there the source of the
trouble, which, if undiscovered, would
render useless the work of the medical
inspector in the school. The school
nurse is the most efficient .possible link
between the school and the home. Her
work is immensely important in its
direct results and far-reaching in its
indirect influences.
Don't get the medicine habit, and
don't get peeved with your physician
if he tells you that you need to take
things easy and spend more time rest-ing
in the open air, or if he tells you
to change your diet and drink more
water and at the same time does not
give you any medicine to take. In
such a case you will have at least the
consolation that you have an honest
man for your doctor.
THE HEALTH BULLETIN 37
AN OPEN LETTER
A Case IVherein a Friend Becomes a
Dangerous Enemy
G HE following letter is a reply to
an inquiry which is typical of
gPgl many received by the State Board
oi Health, asking if anything can be
done to prevent a certain class of af-flicted
persons from spreading their
affliction:
Dear Sir:—I don't know what to
advise you in regard to your friend
C . I know how uncomfortable
you must feel to have such an un-suspecting,
dangerous person in the
oflice with you, especially if he
smokes, coughs and spits on the floor,
stove and everything else as you say,
and refuses to have any ventilation
whatever. From your description of
his cough and other symptoms, I
should think he ought to be in a sana-torium
right now where he would learn
not only how to take care of himself,
but how not to be a menace to others.
If he were a hog and had hog
cholera, of course the State veteri-narian
would take the very best care
of him and he would see to it that he
did not in any way endanger the re-mainder
of the herd. If he were a cow
and had the foot-and mouth disease,
the federal authorities would be down
there in great shape and not only your
little town, but doubtless j^our county,
and perhaps the entire State of North
Carolina, would be quarantined. Now,
of course, since your friend C is
only a human being and the rest of
you are nothing but human beings, I
don't see any hope for you. The State
Board of Health, of course, would like
to see your friend C have a thor-ough
physical examination just as we
would like very much to have every
person in North Carolina have such
an examination, and if there is any-thing
wrong with him, to have the
defects remedied at once Instead of
endangering his fellow-men.
In one of the counties, a few days
ago, an epidemic of hog cholera broke
out, and had continued four weeks
when an Indignation mass-meeting was
held and, as I understand, a county
board of health for hogs was instituted
who are going to wipe hog cholera out
of the county.
It would, of course, be just as easy
to wipe" typhoid fever, tuberculosis, or
any of the other contagious diseases
out, but human beings are human be-ings
and hogs are hogs.
HEALTH AND MORALS
No social agency is more earnest in
its demands upon the church for co-operation
than is the cause of public
health; no agency, to my mind, offers
a greater return for such cooperation.
Public health asks the church to join
hands with it in giving men better bod-ies,
and it promises that when men's
bodies shall be stronger, their spirits
will be nobler. Public health asks the
church to assist it in making sanitary
the community to which the church
ministers, and it pledges the experi-ence
of the world to show that, when
this is done, none will benefit more
than the church. All things being
even, the healthy man is the moral
man; other considerations alike, the
sanitary community is the spiritual
community.—Dr. Ennlon G. Williams.
HEALTH OFFICERS PUT BAN ON
DRINK
At the annual convention of the
Health Officers' Association of New
Jersey, held recently in Newark, the
following resolution was adopted:
Whereas, alcoholic beverages are
detrimental to health and indirectly
the cause of disease:
Resolved, That the Health Officers'
Association recommend that a cam-paign
of publicity be inaugurated by
the State and local departments of
health for the purpose of informing
the public of the dangers to life and
health which attend the use of such
beverages.
38 THE HEALTH BULLETIN
THE NEWSPAPER AND THE PUBLIC HEALTH
Extracts from an Address by Mr. Wade H. Harris before the
North Carolina Medical Society at Durham, April 19, 1916
Iv^IHE banishment of liquor from the
r^ medicine chest accelerates the
^"^ approach not only to a new and
better standard in public health, but in
the morals of the country. In recent
days the world has stood in shocked
and sorrowful contemplation of the
god of war charioteering through a
continent and leaving an overwhelm-ing
river of blood in his trail, but the
weeping of the widows and the wailing
of the orphans assailing his ears is
only a faint echo against the tumultu-ous
wave of anguish that has swept
over the civilized nations for ages past
in the wake of King Alcohol. Liquor
has drenched the world in a volume of
tears that would cleanse the battle-fields
of all peoples from every crim-son
stain.
The changing condition is not being
wrought because the doctor of today
is possessed of more courage than the
doctor of yesterday, but because he
lives in the light of a better knowledge
and has the assistance of the news-papers
in spreading this light. The
doctor is not making a fight on whis-key
in the prohibition sense of the
word. He is waging a campaign for
temperance and health. It is a fight
for health without alcohol.
It is probable that the most conspic-uous
local service rendered the medi-cal
profession and the State by the
newspapers has been in the typhoid
fever campaign. At the outset there
was encountered a prejudice that bid
fair to balk the efforts of the doctors,
but the papers inaugurated a cam-paign
of education which was attended
with excellent results. The State Board
of Health, through the Laboratory of
Hygiene, manufactured and furnished
vaccine free of charge to the people of
the State, and 12 entire counties were
covered. In these 12 counties 51,824
people were given complete immuni-zation
from typhoid. The typhoid
cases were brought down in those 12
counties from 175 in 1914 to 132 in
1915. In addition to the people treated
in the counties named, fully 50,000
have had treatment by whole-time
health officers and various organiza-tions.
A more striking illustration of the
benefits of vaccination may be ob-tained
by the experience of counties
that conducted vaccination campaigns
and counties that did not. Ruther-ford
County was one of the latter.
The typhoid death rate in that county
increased 300 per cent during the time
that the typhoid death rate in the ad-joining
county of Henderson, that had
conducted a typhoid campaign, de-creased
25 per cent. In consequence
of a campaign conducted in Wayne
County, its typhoid death rate was re-duced
65 per cent. The adjoining
county of Lenoir did nothing, and its
death rate increased 25 per cent. Sta-tistics
for the vaccination campaign in
the State as a whole are not yet avail-able,
but there is little doubt that the
instances cited are fairly representa-tive
of results in other counties.
Enough is known to make sure of the
fact that in the assistance rendered
the State Board of Health in so ma-terially
abating the typhoid fever men-ace
and in so short a time the news-papers
have proved themselves a boon
to humanity.
One of the proudest successes to the
credit of the doctors of North Caro-lina
is found in the establishment of
THE HEALTH BULLETIN 39
the State Sanatorium for the Treatment
of Tuberculosis, and yet it is doubtful
if this success could have been attained
at this time but for the useful work
of the newspapers in creating a public
sentiment in favor of that institution.
Its benefits were persistently exploit-ed,
prejudice was combatted, and the
Sanatorium was popularized through
the educational efforts of the press in
its behalf. The newspapers have also
lent their influence to the general cam-paign
against tuberculosis throughout
the State, and there again the influ-ence
has been powerfully effective.
In still another direction, that of
educating the people to the importance
of medical inspection for the public
schools, the newspapers have proved
an excellent ally of the doctors. The
pie in the sane and safe rules of good
health and to the importance thereof
—
they could in the course of time rid
the State of all preventable diseases,
and that happy condition once se-cured,
a public that should come into
an appreciation of immunity and its
blessings could be depended upon to
maintain it. There should be no rea-son
why we could not have a State
clear of disease of a preventable na-ture.
But we should not be content
to stop there. The newspapers and
the physicians should set the higher
mark of giving North Carolina the fin-est
health record of any State in the
Union. With the doctors leading the
way and the papers urging the people
to follow on, our State might easily
be placed at the head of the list. The
Tlie most important work of the press has been in the battle for good
healtli against alcohol. Where former traditions had it that liquor was
good for eyery ailment that flesh is heir to, the papers have brought the
people to the understanding that it is good for none. In the creation
of a prejudice against alcohol as a medicine, the papers have laid a
foundation upon which the doctors have easy work to build, for, with
alcohol banished, the most common and the most insidious enemy to
public health disappears.
wisdom of this advanced step in safe-guarding
the health and even the lives
of the children has had abundant evi-dence
in a recent outbreak that caused
all the schools and even the churches
in one town in North Carolina to be
closed. During the prevalence of the
epidemic responsible for the closing
of the schools and churches, the over-looked
matter of medical inspection
for the schools received discussion, out
of which, it is to be hoped, much bene-fit
will flow to the entire State, for the
value of the ounce of prevention never
before had a more impressive demon-stration.
The doctors and the papers! The
health and happiness of the people of
a great State are largely in their keep-ing.
"Together let us beat this ample
field." Combining their efforts to fe-common
end—the education of the peo-fight
for a State with the minimum
of conditions productive of disease and
the maximum of health has been more
than half won. The medical and health
organizations have brought about re-sults
out of which should come every
encouragement to renewed endeavor.
The work of the present day has one
tremendous advantage over that of the
pioneers in the good-health campaign
in North Carolina. It has an educat-ed
public sentiment behind it, and it
has an enlightened cooperation. We
are out of the woods. The crest of the
hill has been negotiated, the rougher
places have been left behind, and the
going is good. In the noble task of
giving North Carolina a clean face and
a sound body, God speed to the excel-lent
and capably organized service rep-resented
in this gathering.
WHY DOCTORS SHOULD KEPOET
TUBERCULOSIS
To the Doctors' Adyantage as Well as
to the Patients' and Public's Good.
ijrt|E have seen that the physician
^^ who does not report his cases of
tuberculosis to the Bureau of Tu- ^
berculosis thereby violates the law, and
prevents knowledge of the existence of
a new center of possible infection com-ing
to those whose duty it is to pre-vent
contagion. Such a physician oc-cupies
precisely the same position as
the citizen who would not report a fire
to the fire department through the
alarm box.
One would be led to think, from the
general high character of the medical
profession, that such evasions or vio-lations
of the law would be beneath
physicians. Yet the fact remains, in
this State that physicians are not re-porting
their cases of tuberculosis in
anything like the volume in which
these cases occur. They are doing so
more and more, however.
The question arises, why do not the
doctors report their cases of tubercu-losis?
Here are some of the reasons:
Why Doctors Do Not Report
All doctors do not know tuberculosis
when they see it in its early stages.
The fullest knowledge of the diagnosis
and treatment of tuberculosis is of
recent acquirement, and physicians
who learned their art two or three de-cades
ago, and have been so busied
with practice as to be unable to keep
up a progressive course of study,
simply do not know what may be
termed "the fine points" of modern
diagnostic science with reference to this
disease. It is emphatically stated by
the highest medical authorities that
when the symptoms of the disease be-come
sufficiently advanced for the phy-sician
of this type to recognize them
all hope is past for the patient. Not
knowing the disease, some doctors,
therefore, cannot report it.
Then, there are physicians who be-lieve
that it is not wise to tell a patient
when he has tuberculosis, or con-sumption.
The medical' profession is
limiting more and more the scope of
this practice of secrecy, but it still ob-tains
where much more harm than
good i

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THE LIBRARY OF THE
UNIVERSITY OF
NORTH CAROLINA
AT CHAPEL HILL
THE COLLECTION OF
NORTH CAROLINIANA
C6lU
N86
V.C31-323
1916/18
FOR USE ONLY IN
THE NORTH CAROLINA COLLECTION
*l
:
^,^
1 This Bullelin. will "be aentfree to arwj citizen of the Stale upoa dequest. j
Entered as second-class matter at Postoffice at Raleigh, N. C, under Act of July 16, 1894.
Published monthly at the office of the Secretary of the Board, Raleigh, N. C.
Vol. XXXI APRIL, 1916 No. 1
CONSERVE THE PUBLIC HEALTH
HEALTH PLANK IN THE PLATFORM ADOPTED BY
DEMOCRATIC PARTY, APRIL 25, 1916
The conservation of public health is now
recognized as a problem demanding considera-tion
of all enlightened governments. We rejoice
in the splendid progress made by our State in
combating diseases among our people, in reduc-ing
our death rate, in increasing the sum total of
health, happiness, and efficiency of our citizens,
and in establishing a justifiable record of health-fulness
as compared with other States of the
Union. We advocate a continuance and strength-ening
of the humane policy now in force in this
State for the protection of the public health, and
the eradication of preventable diseases.
'O
TABLE OF CONTENTS
Editorial Brevities 283
The Dklayed Bulletin 283
Doing a Good Work 283
An Oi'EN Letter 284
Thorough Physical Examination
Nkcessary 284
A Fellow-Worker Symi-athizes. . 285
Public Health and Sanitation. . . 286
Typhoid Fever 286
Model Creed for Health Clues. 288
Health and Morals 2S8
A Typhoid Tragedy 288
Personal Hygiene 289
Taking Care of Business Men. . . 289
Bad Breath 291
The Germ of Life Discovered. . . 291
Overeating Shortens Life 292
Advice on the Use of Patent
Medicines 292
Child Hygiene 293
For the Mental Health of Chil-dren
293
Infant Mortality 293
"Baby" Jones 293
Medical Inspection of Schools. . 294
Why- Xurse Your Baby? 295
Where Typhoid Spreads 296
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
J. Howell Way, M.D., Pres., Waynesville
Richard H. Lewis, M.D., LL.D., Raleigh
.J. L. Ludlow, C.E., . . Winston-Salem
W. O. Spencer, M.D., . . Winston-Salem
Thomas E. Anderson, M.D., . Statesville
Chas. O'H. Laughinghouse,
Edward J. Wood, M.D., .
Cyrus Thompson, M.D., .
P. R. Harris. M.D., . .
M.D.,
Greenville
Wilmington
. Jacksonville
Henderson
Official Staff
W. S. Rankin, M.D., Secretary of the State Board of Health and State Health Officer.
C. A. Shore, M.D., Director of the State Laboratory of Hygiene.
Warren H. Booker, C.E., Chief of the Bureau of Engineering and Education.
L. B. McBrayer, M.D., Superintendent of the State Sanatorium.
J. R. Gordon, M.D., Deputy State Registrar.
G M. Cooper, M.D., Chief of the Bureau of Rural Sanitation.
Miss Mary Robinson, Chief of the Bureau of Accounting.
FREE PUBLIC HEALTH LITERATURE
The State Board of Health has a limited quantity of health literature on the subjects
listed below, which will be sent out, free of charge, to any citizen of the State as long as
the supply la.sts. If you care for any of this literature, or want some sent to a friend, just
write to the State Board of Health, at Raleigh. A postcard will bring it by return mail.
No. 12. Residential Sewage Disposal Plants.
No. 19. Compilation of Public Health Laws
of North Carolina.
No. 23. The Vital Statis^tics Law.
No. 27. The Whole-Time County Health Of-ficer.
No. 30. Measles.
No. 31. Whooping Cough.
No. 32. Diphtheria.
No. 33. Scarlet Fever.
Anti-Spitting Placards (5 inches by
7 inches).
No. 39. Tuberculosis Leaflet.
Anti-Fly Placards (14 inches by 22
inches).
Anti-Tvphoid Placards (14 inches
by 22 inches).
Anti - Tuberculosis Placards (14
inches by 22 inches).
No. 41. Tuberculosis.
No. 42. Malaria.
No. 44. State Policy for the Control of Tu-berculosis.
No. 45. The Control of Smallpox.
No. 46. Compilation of County Healtli Laws.
No. 47. Privy Leaflet.
No. 50. Baby Leaflet.
No. 51. Rules and Regulations of County
Boards of Health.
No. 52. Malaria and What Everybody
Should Know About It.
No. 53. Disinfection After Diphtheria,
Measles, or Whooping Cough.
No. 54. Disinfection After Scarlet Fever.
No. 56. Tuberculosis Leaflet No. 2.
No. 57. Health Helps for Teachers.
No. 58. Fly Leaflet.
No. 59. Typhoid Fever Leaflet.
Sanitary and Hygienic Care of
Prisoners.
No. 60. Cancer Leaflet.
No. 61. How to Nurse a Tuberculous
Patient.
No. 63. Health Catechi.sm.
No. 67. Adenoids.
No. 68. Pellagra.
No. 69. Quarantine Rules and Regulations
for Infantile Paralvsis.
The Child.*
Teeth, Tonsils, and Adenoids.*
How to Live Long.*
Hookworm Disease.*
A War on Consumption.*
Milk.*
Some Facts About Scarlet Fever.*
Tvphoid Fever and How to Prevent
It.*
Ho-vv to B\ii1d a Sleeping Porch.*
Dental Lecturest
Dental Hygienet
*Furnished by courtesy of the Metropolitan Life Insurance Company.
jFurnished by courtesy of Colgate & Company.
EDWARDS » BROUSHTON PRINTING CO.. RAtEISH. N C
omii
PUE>U5AEJ> Sr TML noR.TA CaJquMA 5TATL BQMe.p q^-mlALTM I
Vol. XXXI APRIL, 1916 No. 1
EDITORIAL BREVITIES
THE DELATED BULLETIN
The State Board of Health calls at-tention
to the fact that while this and
several other issues of the Health
Bulletin will appear late, the cause is
in no way chargeable to this Board or
to the Commissioner of Labor and
Printing. Although the printing fund
of the Board has been exhausted,
through the courtesy of the State
Printers, Edwards & Broughton Print-ing
Company, and the Commissioner
of Labor and Printing, the Board will
be enabled to continue the publication
of the monthly Health Bulletin, al-though
in reduced size. Just at this '
time, however, conditions prevailing in
the paper market render it impossible
to secure paper at a reasonable price
in sufBcient quantities to issue the
Bulletin on time. It is hoped that
normal conditions in the paper market
will soon obtain and that the Bulletin
may appear again on time.
Typhoid fever always represents an
unnecessary waste—either of time,
money, or human life.
One dose of anti-typhoid vaccine
does not offer immunity against ty-phoid
fever, but three doses or the
complete treatment does. If you are
going on a trip this summer or on
your vacation, give yourself time to
jMake the three doses before leaving.
'VThis requires but two weeks, as the
j):^oses are given seven days apart.
There are just two simple rules
which, if every man and woman would
heed, would save many an accident
and many a death. They are: Neither
give nor take medicine from an un-labeled
bottle, and neither give nor
take medicine without first reading
the label.
"Go after the stables" and "Clean
up and keep clean" are the two most
successful methods yet found for rid-ding
a town of flies. "There is no
royal road to freedom of flies," says
Mr. L. C. McCormick of Asheville,
"but clean up and keep clean is the
winning slogan."
THOROUGH PHYSICAL EXAMINA-TIO>
NECESSARY
Advice of Dr. Rankin—What Consti-tutes
Tlioroug-h Examination
~~|-' -^ the following correspondence,
^^ containing a letter from a chron-
*®^^ ic sufferer setting forth his ills,
and the advice given him by Dr. W. S.
Rankin, of the State Board of Health,
the need of a thorough physical ex-amination
is urged, and what consti-tutes
such an examination is clearly
suggested. "Go to a well recognized
physician and be thoroughly exam-ined,"
is the keynote of Doctor Rank-in's
advice.
This correspondence is a type of a
feature of health work done by the
284 THE HEALTH BULLETIN
Board through correspondence, and
represents not a small class of people
who frequently call for help.
State Board of Health, Raleigh, N. C.
Dear Sirs:—I have had a very bad
stomach and bowel trouble for the
past two years. My doctors have
treated me for nervous indigestion, but
have^'failed to do me any good.
I have a craving appetite for food
and can eat most anything, but every-thing
I eat except sweet milk seems
to hurt me. My stomach and bowels
pain and ache most all the time and
are worse just after meals than any
other time. I have heart-burn and am
very nervous when trying to work. I
am very much constipated and have
to take oil daily. I have soreness or
tenderness in left side just above left
hip bone and under left shoulder blade.
Have soreness or pains in my back
near or in my kidneys.
I am a married man, 35 years old.
I weigh 1.50 pounds, but am not losing
much in flesh. I do not drink, smoke,
nor chew tobacco. I have had ca-tarrh
of head and throat for twenty
years. I hawk up scales and my breath
smells bad, but I do not cough. Please
consider my case and advise me.
Doctor Rankin's Reply
Dear Sir:—What you need is a very
thorough physical examination. No
intelligent physician could prescribe
for your case without making such an
examination. By that I mean to get
your full history, including the his-tory
of your past life and your hered-ity
history, and then make a thorough
physical examination of you, including
certain laboratory tests. To attempt
to prescribe for you by mail or to pre-scribe
for you without the advantage
of a full examination, clinical and
physical, would be to guess at your
trouble and subject you to a loss of
time and perhaps to expenses of treat-ment
that would be unfair to you.
I would, therefore, advise you to go
to some well recognized physician and
be thoroughly examined. Medical
treatment based upon anything except
a thorough examination is guess work,
and frequently causes patients a loss
of time which results in a curable dis-ease
becoming an incurable one. A
chronic trouble such as you describe,
which has been so costly to you in its
inroads on your vitality and physical
efficiency, should call for a most care-ful
examination. Such an examina-tion
will require a careful questioning
by a physician probably lasting from
fifteen minutes to a half hour, a very
thorough physical examination of your
chest and abdomen bared, a labora-tory
examination of your urine, proba-bly
of your blood, and it certainly
seems to me, from what you tell me in
your letter, that you should be given
certain test meals, have the contents of
your stomach withdrawn through a
stomach tube and tested for the extent
of digestion. If you haven't had such
an examination, go to a physician who
can give you this thorough form of
treatment.
A FELLOW-WORKER SYMPATHIZES
The following letter is typical of a
number of very kind expressions re-ceived
recently regarding the depleted
printing fund of the Board. This fel-low-
worker's sympathy and kind words
of encouragement are sincerely appre-ciated.
The delayed March number of your
bulletin has just come to hand. I am
sorry to read the announcement con-cerning
the difficulty you are having,
and hope that you will soon be able to
get additional funds for continuing the
publication of the bulletin in its origi-nal
form. I can honestly say that
there is not another bulletin which I
look forward to as much as I do yours.
Whenever I have occasion to teach
students about preparing material for
such bulletins, I hold yours up as a
model. I am sure it must be doing a
good work.
With kind regards, I am,
Sincerely yours,
CHARLES BOLDUAN,
Director, Bureau of Public Health
Education, New York City De-partment
of Health.
"To cure is the voice of the past; to
prevent is the demand of the future."
—Buffalo Bulletin.
The one indispensable asset of the
working man is health.
"It is in the power of man to rid
himself of every infectious disease."
—
Pasteur.
TAKING CARE OF BUSINESS MEN
^m
IVlij- the Business Man is Especially
Prone to Arterio Sclerosis
By Chas. O'H. Laughinghouse, M.D.,
Greenville, N. C.
OME phases of preventive medi-cine
can best be taught by boards
of health, some by practicing
physicians; but to acquaint the public,
especially the energetic business man,
that there is such a thing as arterio
sclerosis and that it is largely pre-ventable,
is worth the effort of the
profession as a whole.
We show the consumptive how to
prolong and save his life. We take
care of the defects of school children.
We teach everybody how to avoid in-fectious
and contagious diseases. We
vaccinate for smallpox. We immu-nize
against typhoid. We print and
disseminate information for all kinds
and conditions of men, and we do it
largely through the business man's
influence, his money, his vote, and his
cooperation. Therefore we most em-phatically
owe it to him to give freely
of whatever information we possess
which tends to prolong his life, en-hance
his happiness, and further his
usefulness.
None of us who live long enough
can avoid growing old. But the busi-ness
man's manner of living is so
conducive to the premature appear-ance
of arterio sclerosis, or harden-ing
of the arteries, that he, above all
others, is most markedly prone to ac-quire
it. The best type, today, is liv-ing
too rapidly, burning the candle at
both ends, growing old prematurely,
so much so that it is alarming how
short a time he stays young. Think
of the millionaire widows in the world.
The business man eats too fast and
too much. Many drink too much.
He throws into his circulatory
system without knowing it exces-sive
food and fluids, combined fre-quently
with toxic products, which
cause too early a condition of high
arterial tension. He neglects his bow-els
and thereby causes absorption of
poisonous products from the intestines
which brings about a rise in blood
pressure. He foregoes even mild exer-cise,
which is an essential feature to
the art of living long. If he does not
abuse his body by over-eating and
drinking, and so wear out his splanch-nic
vessels, excessive brain work and
worry and all their attendant evils
become his habit.
He should be taught that he is en-tirely
dependent on his circulatory
system, and that every man is as old
as his arteries; that the thorough
chewing of food is a process that keeps
men a long time young; that requisite
sleep and recreation by bodily exer-cise
is essential to all animal life; that
excessive work, worry and nervous
tension puts a something into the tis-sues
which hardens the arteries and
raises blood pressure; that alcohol
brings about brittle arteries; that sex-ual
excess and syphilis cause arterio
sclerosis.
The prevention of premature arterio
sclerosis may well be labeled a p'ea
for a rational plan of daily living to
286 THE HEALTH BULLETIN
which moderation is the key-note. To
grow old gracefully is an undertaking
which must be begun when young.
Habitual bodily hygiene, not only as to
diet, exercise, temperance, sleep, and
rest, but recreation as well, should be-gin
early in life. There should be men-tal
change. One's life should be planned
so as to bring into each day a diversi-fication
of mental exercise, a diversi-fication
of interests. It is restful—so
much so that some wise man has said
that "rest is but change of occupation."
Hobbies are ofttimes the salvation
of business men. They may be ridden
hard, for they help to bear men away
from daily cares, business ruts and
worries.
The man who can best keep the
balance between his mental and physi-cal
work is the man who accomplishes
most, is happiest, and who, all other
things being equal, will live and pro-duce
the longest.
The trend of modern medicine is to-ward
prevention. We possess State
authority to control epidemics. We
urge over and over again the value of
early diagnosis in all chronic diseases.
We know that many of them—and this
applies particularly to arterio scle-rosis—
can be largely prevented by the
recognition of and the institution of
proper hygienic and medical treatment.
It is every physician's duty to in-struct
the business man in the funda-mental
rules of health. Accurate
knowledge concerning the prevention
of disease should be spread among the
laity. Correct information concerning
the modes of infection and dangers of
waiting until disease is well advanced
places people where they can with
greater certainty nip ill health in the
bud. It is difficult to turn people away
from the habit of having a drug clerk
prescribe for their ills, but they can
be educated out of it. It is unfortu-nate
that most of the pains and aches
that flesh is heir to speedily pass away
with little or no treatment—for herein
lies the strength of charlatanism and
quackery. Unfortunately, yes, for a
man cannot tell whether the trivial
complaint from which he suffers is
any different from the one that was
easily conquered six months ago. But
instead of recovering he grows worse.
Hope leads him to dilly-dally until he
at last seeks medical advice only to
find that the disease has made such
progress that little can be done. Is
the profession or the public to blame?
The fight for existence is keen. Com-petition
in profession and trade is
acute. So much so that to rise above
the average requires exceptional phys-ical
as well as mental powers; there-fore
we should instruct the business
man to consult his doctor twice each
year. He has an expert go over his
automobile at stated intervals just to
prolong its life and efficiency. He
takes an inventory of his business as-sets
and liabilities each fiscal year.
He studies this and that branch of
his affairs with an eye-view to safety
first. He employs this system and
that so as to stop business leaks. He
pays large amounts annually for in-surance,
life and fire. Yet he fails to
have an efficient engineer go over his
greatest business asset, namely, him-self.
And his failure is because he
has not had the importance of it
brought to his attention. The dentist
has his patients return at stated in-tervals,
only to see if all is well. How
much more rational would it be if men
and women past the age of forty had
a careful physical examination made
twice a year just to find out if all is
well.
PfO EMPLOTMEM FOR CIGARETTE
SMOKERS
When two men such as Edison and
Ford join in the crusade against cigar-ettes,
no father or mother can fail to
look with anxiety upon the beginning
of the habit in a son or daughter. Mr.
Ford says to his friend, the American
boy: "If you will study the history
THE HEALTH BULLETIN 287
of almost any criminal, you will find
that he is an inveterate cigarette
smoker. Boys who smoke cigarettes,
as a usual thing, go with other smok-ers
to the pool-rooms and saloons.
The cigarette drags them down. Hence,
if we can educate them to the dangers
of smoking, we shall perform a ser-vice."
Mr. Edison says, in speaking of the
degeneration produced by narcotics
and cigarettes: "Unlike most narcot-ics,
this degeneration is permanent
and uncontrollable. I employ no per-son
who smokes cigarettes." This is
a lesson that every father and mother
may well take to heart. Already some
of the greatest industries of this coun-try,
especially the railways, refuse to
employ any one who uses alcoholic
beverages. Now one of the greatest
industries of this country, that presid-ed
over by Mr. Edison, refuses to em-ploy
any one who smokes cigarettes.
It is not difficult to see that the boy
who learns to use tobacco is loading
himself with a heavy handicap for the
race of life. He is excluding himself
from employment in some of the great-est
industries in the world.—Harvey
W. "Wiley in Good Housekeeping.
OVEREATING! SHORTENS LIFE
BAD BREATH
The cause of bad breath may be the
nose, the tonsils, or the teeth. Al-though
the proof is not conclusive, the
probability is that the most frequent
cause is the absorption of certain sub-stances
from the intestinal tract. The
proof is conclusive that under certain
circumstances aromatic substances
are formed in the intestines, absorbed
into the blood, and excreted by certain
organs. One way to temporarily re-lieve
bad breath is to take a purge and
eat very lightly for three days. Bad
breath is often present in the consti-pated.
Be the weather foul or fair,
Man always needs the good fresh air.
Heaxy Diners Are Bad Risks, Sajs
Life Insurance Actuary
^ XSURANCE statistics show that
rzj, the man who overeats as well as
™™" the man who indulges in alco-holic
drinks is a bad risk, according
to Arthur Hunter, a life insurance
actuary. Mr. Hunter delivered a warn-ing
against over-indulgence in an ad-dress
to a Young Men's Christian As-sociation
recently. He said that the
heavy diner as well as the heavy
drinker was sure of a short life, but
seldom a merry one, because the con-ditions
under which he lived precluded
the full enjoyment of either mental or
physical well-being. But at the top
of the list of life-shortening habits he
placed the use of alcoholic liquors.
"Seventy years ago," said Mr. Hun-ter,
"an abstainer was unknown. When
the first abstainer applied to a large
London company for insurance a spe-cial
meeting of the board of directors
was called to deal with this phenome-non,
and a special premium was de-manded.
Contrary to all expectations,
this man lived to be 82 years old."
—
Daily News, Chicago.
Keep well is the slogan that is
sounding ever louder and louder, and
with this slogan should go the supple-mentary
advice that when sick early
treatment is the safest and surest
treatment. As the twig is bent, the
tree is inclined. It is comparatively
easy to straighten the twig, but the
"inclined" tree is likely to break un-der
the strain of a curative effort.
Just so with the human; defects and
physical impairments are much more
easily remedied in early life than in
the middle or advanced ages, and near-ly
all illnesses are much more readily
cured in their early than in their ad-vanced
stages.
Swat the fly, now.
INFANTILE PARALYSIS OR POLIOMYELITIS
By Db. W. S. Rankin, Secretary of the North Carolina State Board of Health
History
This disease was first, recognized by
von Heine in 1840. A significant fact
bearing on the comparatively slight de-gree
of contagiousness of this disease is
that it was not until 47 years later, in
1887, that it was observed to occur in
epidemic proportions. It is only recently,
since 1907, that the disease has been rec-ognized
in the United States in epidemic
form. Since that time epidemics have
occurred in New Yoi'k City, Massachu-setts,
Rhode Island, Minnesota, Wiscon-sin,
Iowa, Texas, Pennsylvania, and in
lesser degree in other places. The pres-ent
epidemic in the City of New York,
which, at the time of this writing, has
reached the unprecedented level of nearly
7,000 cases, marks the height of the epi-demic
development of infantile paralysis.
Cause
Out of the confusion of conflicting theo-ries
as to the mode of transmission of
infantile paralysis, it seems best to set
down the few established facts regarding
the propagation of the disease, and then
to state the more important theories in
their relation to the facts:
Fact No. 1.—The disease is a disease of
childhood. Over eighty per cent of the
cases are under 3 years of age. In the
present New York City epidemic, ninety-nine
per cent are under 16, eighty-five
per cent under 5, and fifteen per cent
under 1 year of age.
Fact No. 2.—The disease is character-istically
a disease of the summer months,
prevailing most extensively in hot, dry
weather. The disease, unlike the more
typically contagious diseases, does not,
as a rule, tend to spread during school
months, but occurs usually during the
time when the schools are closed.
Fact No. 3.—Infantile paralysis is only
slightly contagious. The disease affects
but a small proportion of those exposed
to it. Of 2,070 persons known to have
been fully exposed to infantile paralysis,
only fourteen developed the disease in
its paralytic form. In four different
schools in each of which occurred a case
of infantile paralysis no secondary cases '
developed. Under ordinary conditions,
cases of the disease are taken into the
general wards of hospitals without isola-tion
from patients sick from other dis- >
eases. As a rule, the incidence of the
disease, that is, the proportion of the
population coming down in an outbreak
of the disease, is not over one person in >
a thousand or two thousand. In smaller
communities the incidence may be
greater. In the present epidemic in New
York City the incidence is about one to ^
five hundred. This heavy incidence is
very probably without a precedent in
the history of infantile paralysis.
Fact No. 4.—The disease is character- '
istically a rural disease, tending to pre-vail
in small towns or cities rather than
in large cities, and in rural rather than
in urban districts. *
Fact No. 5.—The disease shows no se-lective
tendency toward particular social
groups, involving alike the rich and the
|
poor, those living in good surroundings,
well fed and well clothed, and those liv-ing
in the tenements, underfed and poorly
clad. /
Fact No. 6.—The dissase is due to a
germ. This germ has been obtained from
the following sources: (1) From the
body and from the secretions of the noses '
and mouths and intestines of persons
dead of the disease. (2) From the secre-tions
of the noses and mouths and intes- /
tines of persons sick with the paralytic
form of the disease. (3) From the secre-tions
of the noses, mouths, and intestines ,
of persons sick with the nonparalytic
form of the disease, that is, the abortive
or atj^pical cases. (4) From the secre- '
tions of the noses and mouths of persons
THE HEALTH BULLETIN 289-
who have recovered from the disease
several months previously. (5) From the
secretions of the noses and mouths of
well persons who have not themselves
had the disease in recognizable form, but
who have been exposed to persons suf-fering
from the disease. The germ on"
the disease can be inoculated into mon-keys
with the effect of reproducing the
typical disease in the monkey. It is ques-tionable
whether the germ can be inocu-lated
into the monkey without breaking
the skin or mucous membrane of the ani-mal.
The importance of this statement
will later appear. Infected and diseased
monkeys placed in cages v.ith other mon-keys
do not conve}^ the disease to their
companions. The germ of the disease is
not killed by being dried for a consider-able
period of time, which is unlike the
germs of most diseases in that they die
rapidly in the dry state.
Fact No. 7.—The period of time elaps-ing
between exposure to infantile paraly-sis
and the first symptoms of the disease,
technically spoken of as the incubation
period, is not definitely known. It is
usually put down as varying from two
to fourteen days, with eight days given
as the average. However, we know that
in the inoculation experiments on mon-keys,
thirty-three days was the average
time between the inoculation of the mon-key
and the first symptoms of the disease.
In some monkeys nearly two months
elapsed before the disease developed.
There is one case on record where the
monkey was inoculated a year before it
developed paralysis. There is now in
this State a case that left New York five
weeks before the development of the dis-ease.
This variation in the period of in-cubation
of the disease is like the vari-able
period of incubation in hydrophobia,
which is anywhere from two weeks to
two years. In this connection it might
be said that the germ, or poison, that
produces the disease resembles that of
hydrophobia in two respects, namely, that
it can be passed through a porcelain
filter and that it is not killed by drying
and by being kept in glycerine; further-more,
both diseases affect the nervous
system.
Fact No. 8.—The disease appears in two
types of cases, the sporadic case and the
epidemic case. By sporadic cases we
mean cases of the disease that have no
traceable connection with an epidemic,
and that are rarely ever followed by sec-ondary
cases, that is, by other cases.
These sporadic cases are always present
in the State but are so separated by
space and time as to have no demonstra-ble
connection with other cases. With-out
accurate statistics, and basing our
estimate purely upon the number of
deaths from infantile paralysis reported
for the year 1915, seventeen deaths, we
would say that in North Carolina every
year there are about 200 sporadic cases
of the disease. There is no record of the
disease ever having prevailed in North
Carolina in epidemic form, by which, of
course, w^e mean the occurrence of a large
number of cases closely related in space
and time. While there is every reason
to suppose that the sporadic case and
epidemic case is one and the same dis-ease,
this has never been absolutely
proved.
Fact No. 9.—So far, there is no proof
that the incidence of the disease has been
influenced by any measures directed to-ward
its control. For example, the most
strenuous fight that has ever been made
on infantile paralysis is now on in New
York City, and the prevalence of the dis-ease
is greater in New York City than at
other times and places where very little
or practically nothing was done to con-trol
its spread.
THEOEIES
The Theory of Transmission from Per-son
to Person: This theory, based upon
the established fact that the germ occurs
in the secretions of the noses and mouths
of persons sick with the recognizable
paralytic form of the disease, persons
sick with the nonparalytic, unrecogniz-able
form of the disease, persons recover-ing
from the disease, persons who have
290 THE HEALTH BULLETIN
not had the disease, but who have been
exposed to it, assumes that the disease
is spread among the people through the
distribution of the nasal and oral secre-tions
in exactly the same way that mea-sles,
whooping-cough, diphtheria, and
scarlet fever are known to be distributed.
We know that the nasal and oral secre-tions
of people are conveyed to others
in the following ways: (1) The common
drinking cup or dipper: One person uses
the dipper or drinking cup and leaves a
small amount of saliva on the cup or
dipper, which the next person who takes
a drink gets into his mouth. (2) Through
acts of coughing and sneezing without
the use of a handkerchief: It is now
positively known that in acts of cough-ing
and sneezing small invisible droplets
of the nasal and oral secretions are ex-pelled
into the air and float in the air
for variable periods of time, for an hour
or more, and for variable distances, for
twenty or thirty feet. Persons coming
into an atmosphere containing infectious
droplets breathe them in and become in-fected.
(3) Through dried expectoration:
A person spits on the sidewalk or on the
floor, the expectoration dries, moving feet
and brooms grind the dry expectoration
into floating or wind-borne dust, the dust
is breathed in, and if infectious it may
cause disease.
This theory of transmission of infantile
paralysis from person to person has to
assume, in order to explain the small
number of cases of infantile paralysis in
proportion to the population, that but a
small number of those who get the germs,
that is, those who become infected, are
susceptible to the disease. We know it
to be a fact that variable degrees of sus-ceptibility
to different diseases exist. To
illustrate: If a hundred children who
have never had measles are thoroughly
exposed to measles ninety-nine will have
measles; of a hundred children who have
never had whooping-cough, but who have
been exposed to whooping-cough, ninety
will have the disease; of a hundred chil-dren
who have never had scarlet fever,
but who become exposed to scarlet fever,
fifty will have the disease; of a hundred
persons who drink water from a typhoid-polluted
well, twenty-five will have ty-phoid
fever and seventy-five will escape.
In infantile paralysis our theory assumes
that the susceptibility of exposures is far
less than in any of the above.
This theory explains the lack of ability
to control the prevalence of the disease
by assuming: First, the existence of
many abortive, atypical cases of the dis-ease
which are not diagnosed as infantile
paralysis on account of the mildness and
on account of the absence of the charac-teristic
symptom, paralysis. Second, the
existence of a large number of persons
infected with the disease but not sick
from it, that is, "carriers." The theory
assumes, for example, that in New York
City where there are at present about
7,000 persons now sick or convalescent
from the recognizable form of the dis-ease,
and a great many others with the
disease so slight in its manifestations as
to have escaped recognition, there are
from fifty to one hundred thousand car-riers,
that is, persons who have not had
the disease, who are not sick from the
disease, but who in some indirect way,
usually without knowing, have come in
contact with and been infected by a case
of the disease. We know that when diph-theria
is prevailing epidemically in a
town or city that, in addition to those who
are suffering from the disease, there are
from three to five per cent of the popula-tion,
as shown by laboratory examination,
infected with diphtheria germs. In other
words, if in a city of 25,000 population,
there occurred in the course of six, eight,
or ten weeks a hundred cases of diph-theria,
there would be walking the streets
of that city from 500 to 1,000 well persons
with diphtheria germs in their throat.s.
The "carriers," the persons walking
about on the street, in the postofflce, in
the street cars, and carrying the germs
with them, are the more dangerous infec-tious
agents in the community, and not
the persons with the germs who are con-fined
to their room. In diphtheria we
can detect "carriers" by a very simple
THE HEALTH BULLETI]>r 291
examination of the throat, but in infantile
paralysis we can not detect "carriers,"
because the detection of a "carrier" de-pends
upon producing the disease in a
monkey through the inoculation of the
monkey with the throat secretions of the
supposed "carrier." Monkeys are not
available in sufficient numbers for mak-ing
wholesale tests for "carriers."
The ^Veakness of This Theory: First,
if infantile paralysis is conveyed like
measles, whooping-cough, diphtheria, and
scarlet fever, through some form of ex-change
of the nasal and oral secretions
of people, then the disease should occur
at the same seasons of the year when the
other diseases conveyed in this way pre-vail,
that is to say, during the school
months. It is in the school, of all places,
especially in the school with the common
dipper and open bucket and the school
where children are allowed to sneeze and
cough into the air without using a hand-kerchief,
that these secretions are ex-changed.
Second, many cases of infantile
paralysis are found in the most isolated
rural communities, and the most careful
and trustworthy history of these cases
go to show that neither the victim nor
any other member of the household has
been to any place where the disease pre-vails,
and further, that no person coming
from any place where the disease prevails
has visited such a household. In other
words, there are many cases of this dis-ease
so isolated that it would seem that
the only common bond of communication
between such a person and other cases
of the disease could be the United States
mail. These extremely isolated cases go
to suggest that some origin other than
contact with another case is necessary in
explaining the cause and transmission of
this disease. Third, one infected monkey
placed in a cage with many uninfected
monkeys does not convey the disease to
the other monkeys.
The Theory That the Disease Is Carried
by Insects: This theory would explain
the greater prevalence of the disease du-ring
hot weather, also the greater preva-lence
of the disease in rural districts, as
the insect population is greater in the
summer and in the country than in the
winter and in the town or city. Dr. Rose-nau,
of Harvard University, once thought
he had transmitted the disease through
the stable fly (not the ordinary house fly),
but he himself and others have since
failed to confirm the experiment on which
he made this claim. In the experimental
production of the disease in monkeys it
does not seem to be sufl^icient to simply
place the germs on an uninjured mucous
surface like the throat; an injury, a break
in the lining membrane, seems necessary
for infection. This is a point in favor
of the bite of an insect as the means of
transmission.
The ^Veakness of This Theory: First,
it does not explain the occurrence of spo-radic
cases, by which is meant cases
without any traceable connection with
any epidemic of the disease. Nor does
the insect theory explain the irregular
distribution of epidemics. For example,
if the epidemic occurrences of the disease
in 1908, 1909, 1910, in Minnesota, Ne-braska,
Iowa, and Kansas were second-ary
to the epidemic in New York City in
1907, as is generally supposed, how is it
that the insect carrier should pass
through Chicago to the western epidemics
without involving Chicago? In 1910 there
was an epidemic in Washington, D. C,
and a smaller one in Philadelphia, but
Baltimore, between the two cities and on
the main route of travel, escaped. Sec-ond,
the insect theory again fails to hold
water in that children almost solely are
infected and adults escape, uuless we as-sume
that adults are not susceptible and
children are. It is interesting to know
that in the present New York City epi-demic
among the 30,000 institutional chil-dren
living in different institutions in dif-ferent
parts of the city, there is not a
single case of the disease; and that on
Barren Island, where much of the gar-bage,
many of the dead animals, and other
city wastes are carried for incineration,
an island separated from the rest of the
city with a population of 1,700 people
with 200 or 300 children, there is not a
292 THE HEALTH BULLETIN
single cate of infantile paralysis. It
would seem that, with an insect carrier
as active as the present epidemic in New
York City would indicate, there should be
a few cases in some of the institutions
and on Barren Island.
The Dust Infection Theory: This the-ory
was suggested by Dr. H. W. Hill, State
Epidemiologist of Minnesota, as follows:
"With regard to the relation of dust,
and so on; we had a great deal of dust in
the beginning of the outbreak (epidemic
in Minnesota in 1909), when there was
notably hot weather. The corn was actu-ally
drying up. A most striking fea-ture
in connection with this was in Wi-nona.
There were 34 cases which oc-curred
up to the 5th of August. Almost
every case had been on unwatered streets.
They began to water the hitherto unwa-tered
streets on the oth of August, and on
the 12th of August the last case occurred.
There was not another case in Winona, a
town of about 20,000 inhabitants, although
there were cases in the surrounding coun-try
which continued for three or four
months after that.
"There was a somewhat similar experi-ence
in Eau Claire, Wisconsin. It would
seem to me that dust must be a factor in
the disease. For that reason, I am rather
inclined to think that probably the car-riers
of this disease may be found
amongst the lower animals, because, of
course, the only thing we can think of in
dust that can be likely to be a serious
matter is the excreta of animals, espe-cially
of the horse, because the street
sweepings and dust in general of the
street is about half horse manure. I
think fifty per cent of the dust in the
streets of a city is horse manure."
As is pointed out above, the germ or
virus of the disease will live in the dry
state and, therefore, may be capable of
conveyance through dust. The prevalence
of the disease during hot, dry, dusty
weather is corroborative of the dust route
of infection. Its more frequent occur-rence
in the smaller towns and cities and
in country districts where highways are
unpaved and unwatered, as compared
with its less frequent occurrence in larger
places that have well-paved, sprinkled
streets, is suggestive of dust-borne infec-tion.
It seems to be an established fact
that the disease did not prevail in epi-demic
proportion much before the year
1880 or 1890, and that the number of epi-demics
since that time have been steadily
increasing. This fact might be made to
accord with the dust theory of infection
on the ground that a growing civilization
with a greater travel creates more dust
than we had in former times.
The Weakness of the Dust Theory:
Adults do not have the disease in the
same proportion as children, and adults
are as much or more exposed to dust
than children. This fact can be recon-ciled
with the dust theory of infection by
assuming, what seems to be certainly the
case, that children have a far greater
susceptibility to the disease than adults.
The Theory of Auimal Infection: The
occurrence of paralytic diseases among
domestic animals, the dog, cat, chicken,
horse, cow, etc., has suggested that in-fantile
paralysis might be a disease com-mon
to these domestic animals and hu-man
beings, and might, therefore, be con-tracted
from domestic animals. Careful
experimental investigations have failed to
show any relation between paralytic dis-eases
of these lower animals and infantile
paralysis. It is impossible to infect the
lower animals with the virus of infantile
paralysis taken from either infected mon-keys
or children; conversely it is impos-sible
to infect monkeys from animals suf-fering
with paralytic diseases. There is
no evidence to show any connection be-tween
disease of domestic animals and
infantile paralysis.
Control
To control the prevalence of this dis-ease
we endeavor to break the infectious
chain. It would be easy to deal with the
disease if it were known to be due to dust,
for then frequent sprinkling would serve
as an effective agency of control. As we
do not know that the disease may not be
checked in this way, it is well enough, in
epidemics of infantile paralysis, to see
that the streets and much used roads are
kept damp. While it is not likely that the
disease is contracted from domestic ani-mals,
it is not only possible, but extremely
THE HEALTH BULLETIN 293
probable, that dogs and cats and other
pets coming in contact with infected
homes and sick children may, through
association with other children, serve as
a means of distribution of the infection;
therefore, dogs, cats, and other pets,
should be carefully excluded from in-fected
quarters and infected people.
Screening of the sick room is simple and
cheap, and should be carried out, for it is
possible for flies to serve as mechanical
carriers of the poison just as in typhoid
fever. If the disease is found to have
some unknown animal or insect origin, it
would then probably be evident that none
of the methods that have been adopted
for the control of the disease were in the
least effective. If it should be found to
be carried by "carriers," and if what
seems probable should be found to be
true, namely, that the proportion of car-riers
to the number of victims of the dis-ease
is very large, the problem of effect-ive
quarantine would be so extremely dif-ficult
as to be almost worthless.
For detailed, specific rules and regula-tions
governing the control of infantile
paralysis, the reader is referred to Spe-cial
Bulletin No. 69, which contains the
rules and regulations adopted by the Con-ference
of State Health Officers with the
United States Public Health Service on
August 18, 1916. This bulletin can be ob-tained
from the State Board of Health.
Origin of Epidemics.
Contagious diseases prevail sporadic-ally,
endemically, epidemically, and pan-demically.
By the sporadic occurrence of disease
we mean the occurrence of single cases
widely separated by both space and time
from other cases and without traceable
connection with other cases.
By the endemic occurrence of disease
we mean the continuous existence of a
few cases in a place. For example, we
may say that diphtheria is endemic in
New York City, by which we mean the
disease is never completely eradicated
from the City of New York.
By the epidemic occurrence of disease
we mean the occurrence of an unusually
large number of cases of disease closely
related in time and space and showing a
traceable relation to other cases.
By the pandemic occurrence of a dis-ease
we mean the rapid invasion of large
territories by a disease, the best illustra-tion
of which was the pandemic of grip,
or influenza, which started in Russia
some time about 1890 and in one year
traveled around the world.
Explanation of sporadic cases: There
are probably two explanations of spo-radic
cases: A case of scarlet fever or
infantile paralysis develops in the coun-try
or in a town. There have been no
other cases there for months. It is pos-sible
that some person who had recov-ered
from scarlet fever or infantile paral-ysis,
or who had never had the disease
in recognizable form, but who is a car-rier,
met the sporadic case at a soda
fountain, at the rim of a common drink-ing
cup or dipper, or coughed or sneezed
in a street car or postoffice close to the
victim of the sporadic disease, and in
that way caused the sporadic case. The
second explanation of the sporadic case
is especially worthy of consideration in
connection with infantile paralysis. This
explanation would ascribe the sporadic
case to a prolonged period of incubation.
In discussing the cause of the disease, it
was stated that, like hydrophobia, the in-cubation
period, the time between the in-fection
and the occurrence of the disease,
was variable, in inoculated monkeys thir-ty-
three days. One suggestive instance
was cited in which a monkey had the
disease a year after it was inoculated.
So many sporadic cases may be cases of
infantile paralysis infected at the time
of an epidemic, but that come down after
exceptionally long periods of incul)ation.
Explanation for the endemic occur-rences
of disease: Diseases are only en-demic
in very large populations and
where the disease is highly contagious.
It is the smouldering fire, smouldering
usually because the susceptible popula-tion
of a place has been exhausted by an
294 THE HEALTH BULLETIN
epidemic preceding the endemic continu-ance
of the disease.
Explanation of epidemics, or how spo-radic
cases become highly contagious and
epidemic: Under artificial conditions in
the laboratory we may take a disease
germ that has been cultivated or grown
outside of an animal, in a test tube for a
long time, and if we endeavor to produce
disease in an animal by inoculating it
with such a degenerated germ, we find
that we must use, say, for illustration,
ten million germs to kill the animal.
Now we find that if we take this germ
from the animal which it kills and inocu-late
it into a second animal that we can
kill the second animal, say, for illustra-tion,
with a million germs. Again, if we
take the germ from the second animal's
blood and inoculate a third animal, we
can kill it with ten thousand germs; from
the third dead animal we can kill a fourth
with cne thousand germs, and so on, each
successive inoculation requiring fewer
germs for producing a fatal effect. Such
a process of educating a germ to kill, of
raising what the laboratory man calls
the germ's virulence, may be something
like what takes place under natural con-ditions
when a sporadic disease blazes into
an epidemic. We will say, for illustra-tion,
that the sporadic case happens to
be in a child of great susceptibility to the
germ; the germ grows easily and vigor-ously
in such a child's body. By some
chance happening, a second and a third
susceptible person contract the germs,
and there is an increase in the disease-producing
power of the germs. The germ
with increased disease-producing power
then affect a large part of those exposed
to it, an epidemic resulting.
The explanation of pandemics would be
the same as the explanation of epidemics
except the disease-producing power of
the germ would be still more highly
raised.
Farts of Body Affected
There is reason to believe that the germ
or poison of this disease passes through
the upper part of the nose and throat
into the cranium and from there into the
spinal cord, which is directly connected
with the cranium, or brain box. It is
probably for this reason that many caseb
of the disease in the early stages are
characterized by a certain amount of cold,
that is, inflammation of the nose. The
poison or germ, en reaching the spinal
cord, causes an inflammation of the front
part of the cord, usually the front part of
the lower end of the cord. The germ,
however, may cause an inflammation of
any part of the central nervous system,
the brain or the cord or both. The part
of the cord involved in the disease process
is that part that has to do with movement
of the muscles, and of course when this
part is destroyed motion is lost, paralysis
ensues. The part of the body paralyzed
most frequently is shown in the following
table, which is based upon 560 cases:
One lower extremity 229 cases
Both lower extremities 176 cases
General paralysis all extremi-ties,
and more or less of
trunk 79 cases
One lower and one upper ex-tremity
36 cases
Both lower extremities and one
upper extremity 16 cases
One upper extremity alone 14 cases
Both upper extremities 2 cases
All other varieties 8 cases
Symptoms of Infantile Paralysis
In this disease there are two sets of
symptoms which occur either separately
or in varying combination. In one set
there are those symptoms characteristic
of an invasion of the body by disease-producing
germs. In the other set there
are symptoms indicative of an injury to
the central nervous system, more espe-cially
an injury of the spinal cord.
Symptoms of germ invasion are chilly
feelings, of a distinct chill, fretfulness,
irritability, headache, fever from 100 to
104, increased pulse rate, loss of appetite,
sometimes vomiting, usually constipation,
and, in some epidemics, a little cold or
sore throat, indicating the point of en-trance
of the germs into the body. Occa-sionally
there are muscular twitchings
or even convulsions.
THE HEALTH BULLETIN 295
The symptoms indicating an injury to
the spinal cord, and associated with the
above symptoms of infection, are pain in
the back, especially marked in the calves
of the legs and the nape of the neck.
Bending of the body forward, flexing the
head on the neck or the thigh on the body
intensify the pain which is resisted by the
child. Usually within from one to three
or four days after the onset of the symp-toms,
paralysis of some part of the body,
as indicated in the foregoing table, is ob-served,
or, perhaps we had better say,
iiiay be observed.
This brings U5 to a consideration of
what is known as the abortive or atypi-cal
cases, by which we mean cases of
infantile paralysis in which there is no
paralysis, paradoxical as this may sound.
These cases of the disease characterized
by the symptoms of germ invasion only
—
and these symptoms may be very slight,
barely noticeable in many cases—are not
recognized as cases of infantile paralysis
except in epidemics and under suggest-ive
associations. For example, one child
in a family has the typical combination
of symptoms with paralysis of one leg;
another child in the same family has a
little cold, a little elevation of tempera-ture,
some chilly feelings, loss of appe-tite;
maybe it vomits once or twice and has
a little pain in the back. These symptoms
pass away in a day or two. A third child
in the same family is merely indisposed
for a day, does not care about playing,
lies about on the lounge. These last two
children, with no paralytic involvement
and not associated with another case of
paralysis in the family, would never be
suspected under ordinary circumstances of
having infantile paralysis. Nevertheless,
inoculation experiments have shown that
•such abortive cases as we have described
are true cases of infantile i)aralysis. The
important point in this connection is that
in every epidemic of infantile paralysis
there are a large number of abortive and
atypical cases of the disease, cases with-out
paralysis, cases with mild symptoms,
many with symptoms so mild as not to l)o
recognized as being sick at all. Such per-sons
do not themselves suspect the na-ture
of their trouble, no physician ever
sees them, they are not reported for quar-antine,
and usually serve as one of the
most important sources of an epidemic.
Another interesting type of the disease
is the paralytic case with only a few or
with unnoticeable symptoms of germ in-vasion.
A case something like this: A
child three years old is a little bit fretful
in the afternoon, doesn't have much appe-tite
for supper. The next morning, when
the child is being dressed, it is noticed
that one arm or one le^ is weak or limp.
Treatnieiit for Infantile Paralysis
Call in your family physician as soou
as you have reasonable grounds to sus-pect
the presence of the disease and leave
the treatment to him.
ADVICE ON THE USE OF PATENT
MEDICINES
For weak lungs—Purchase a nice cha-mois-
lined chest protector. Put it on your
pet poodle dog, and take ten deep inspi-rations
(breaths) slowly before an open
window each morning. Retire to a warm
bath room and take a cold sponge above
the waist line. This do daily.
For constipation—Take three or four
of Dr. Patent Medicine's Pink Pills. Roll
each pill around the block, using your
hand as propeller. Drink one pint of cold
water before breakfast and at bedtime.
Eat with regularity less meat and more
vegetables. Wash your teeth with a tooth-brush.
Don't forget to thoroughly masti-cate
your food.
For dyspepsia—Procure a box of Char-coal
Dyspepsia Tablets. Put them in your
flower pot. Charcoal is good for house
plants. Go to your dentist and have your
teeth cleaned and filled. Avoid anger. If
fatigued, rest before eating. Select a
good, wholesome diet, avoiding condi-ments
and spices. Avoid midnight
lunches, consisting principally of salads
and coffee.
296 THE HEALTH BULLETIN
WHERE TYPHOID SPREADS
There is probably no communicable
disease in this country the spread of
which we know with as much cer-tainty
as typhoid fever. The manner
in which it spreads or the way by
which it reaches human beings is a
sordid story. So filthy are the facts,
as well as the factors, in the spread of
typhoid fever, that for this reason it
has been called the "national dis-grace."
The plain facts about its spread are
these: The germs are found only in
open-back privies, stables, garbage
cans, etc., to unscreened kitchens, din-ing
rooms, and dairies. They infect
food and drink with typhoid germs,
causing unsuspecting human beings to
contract the disease. Personal un-cleanliness,
particularly of the hands,
is another means of spreading the dis-ease.
The accompanying, picture shows
plainly the surroundings conducive to
typhoid—an open fly-exposed privy and
barn, unscreened kitchen and dairy,
and fly-infected food and drink. The
W
^Hp^*^"^ .„--=
HOW WE GET TYPHOID.
the discharges of the human body,
either in the excreta or urine; these
have to be swallowed, usually in wa-ter,
milk, or with other food, before a
human being can have typhoid; the
three principal factors in the spread
of typhoid are filth, fingers, and flies;
and the control of typhoid fever is
practically the control of these three
factors.
Filth contains the germs of typhoid,
and is carried to food and drink main-ly
by fingers and files. Flies go from
flies go directly from the stables, the
privy, and the dog to the cakes and
pies on the table. Such conditions,
besides being disgustingly filthy, are
an open door to disease and death.
Screen the doors and windows of the
house and milk room, protect the well
and make the privy fiy-proof by build-ing
it fly-tight down to the ground and
placing it over a pit two or three feet
deep by two or three feet square, and
have it at least two hundred feet from
the well.
PuMslvedb^ TnE.^°RTACAR9LI/^/\ STATE. D^ARDs^AmLTA
1 This BulkliAwillbe 5er\X free to arxg citizerx of the Stale upoi\ request !
Entered as second-class matter at Postoffice at Raleigh, N. C, under Act of July 16, 1894.
Published monthly at the office of the Secretary of the Board, Raleigh, N. C.
Vo.. XXXI MAY, 1916 No. 2
Moving Picture Health Car
The State Board of Health has fully equipped this car with a powerful
electric lighting plant, motion picture machine and accessories, together with
a large selection of health and comic films, all of which is in charge of a com-petent
lecturer and machinist. Would you have this car come to your county,
give moving picture health entertainments in a dozen or more places, and wage
a vigorous educational health campaign for from three to six weeks ? Read
pages 20 to 23, inclusive.
TABLE OF CONTENTS
AsHEViLLE Puts Fihst Things First 19
Another Knock-out 19
Public Health and Sanitation 20
Teaching Health by Motion Pictures 20
Hookworm Disease 23
Wht Is A Tonsil? ..- 25
Personal Hygiene 25
Spitting Unnecessary 2(i
Guard Your Health by Watching
Your Kidneys. 26
"Make Health Catching" - -- 27
The Pace That Kills.... 28
It Cost Little to Live a Healthy
Life 29
When Pebuna Was at Its Best 29
Foxes and Tanglefoot 29
Child Hygiene 30
For the Mental Health OF Children 30
Infant Mortality... 30
"Baby" Jones 30
Medical Inspector of Schools 31
Drink More Water 31
A Fool's Paradise. 31
Your Child's Birthright.. 31
Fresh Air and Why. 32
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
J. Howell Wat, M.D., Pres., Wavnesville
Richard H. Lewis, M.D., LL.D., Raleigh
J. L. Ludlow, C.E., . . Winston-Salem
W. O. Spencee, M.D., . . Winston-Salem
Thomas E. Andeeson, M.D., . Statesville
Chas. O'H. Laughinghouse, M.D.,
Greenville
Edwaed J. Wood, M.D., . . Wilmin^on
Cteus Thomi'SON, M.D., . . Jacksonville
F. R. Haeeis, M.D Henderson
Official Staff
W. S. Rankin, M.D., Secretary of the State Board of Health and State Health Officer.
C. A. SHfcEE, M.D., Director of the State Laboratory of Hygiene.
Waeeen H. Bookee, C.E., Chief of tlie Bureau of Engineering and Education.
L. B. McBeatee, M.D., Superintendent of the State Sanatorium.
J. R. Gordon, M.D., Deputy State Registrar.
G. M. COOPEE, M.D., Chief of the Bureau of Rural Sanitation.
Miss Maey Robinson, Chief of the Bureau of Accounting.
FREE PUBLIC HEALTH LITERATURE
The State Board of Health has a limited quantity of health literature on the subjects
listed below, which will be sent out, free of charge, to any citizen of the State as long as
the supply lasts. If you care for any of this literature, or want some sent to a friend, just
write to the State Board of Health, at Raleigh. A postcard will bring it by return mail.
No. 12.
No. 31.
No. 32.
No. 89.
No. 41.
No. 42.
No. 47.
No. 50.
No. 52.
No. 53.
No. 54.
No. 57.
No. 58.
No. 59.
No. 60.
No. 61.
No. 63,
No. 67,
No. 70.
No. 71.
No. 72.
No. 73.
Residential Sewage Disposal Plants.
Whooping Cough.
Diphtheria.
Tuberculosis Leaflet.
Tuberculosis.
Malaria.
Privy Leaflet.
Baby Leaflet.
Malaria and What Everybody
Should Know About It.
Disinfection After Diphtheria,
Measles, or Whooping Cough.
Disinfection After Scarlet Fever.
Health Helps for Teachers.
Fly Leaflet.
Typhoid Fever Leaflet.
Sanitary and Hygienic Care of
Prisoners.
Cancer Leaflet.
How to Nurse a Tuberculous
Patient.
Health Catechism.
Adenoids.
Tuberculosis.
Pellagra.
Smallpox.
MeasL's.
No. 74. Scarlet Fever.
No. 75. Baby Weliare.
No. 76. Save the Baby.
The Child.*
Teeth, Tonsils, and Adenoids.*
How to Live Long.*
Hookworm Disease.*
First .Aid in the Home.*
The Health of the Worker.*
Smallpox and Its Prevention.*
A War on Consumption.*
Milk.*
Some Facts About Scarlet Fever.*
A Few Facts -About Measles.*
Typhoid Fever and How to Prevent
It.*
How to Build a Sleeping Porch.*
Dental Lectures.!
Dental Hygiene.
t
Anti-Spitting Placards (5 inches by
7 inches).
Anti-Fly Placards (14 inches by 22
inches).
Anti-Typhoid Placards (14 inches
by 22 inches).
Anti - Tuberculosis Placards (14
inches by 22 inches).
*Furnished by courtesy of the Metropolitan Life Insurance Company.
tFurnished by courtesy of Colgate & Company.
EDWARDS i BROUGHTON PRINTINS CO . RALEIGH. N. C
Vol. XXXI MAY, 1916 No. 2
ASHEVILLE PUTS FIRST THINGS
FIKST
Gires Public Health First Place of Ini-portance
in Municipal GoYernment
I
FINE example of the thorougli-
^^ ness and efficiency of AsheviMe's
'^*' Health Department is her .jres-ent
campaign for the absolute elimina-tion
of the surface closet. At the
present time Asheville has only about
three hundred such closets. This num-ber
is being gradually reduced by the
laying of new sewers, and it will be
reduced to two hundred by June, and
by midsummer there will not remain
one such closet in Asheville. This is
being done through the ordinary finan-cial
channels, assessing the cost of
such new sewers against the property.
Asheville forces all property without
delay or discrimination to connect with
the sewers as soon as they are ready.
If for any reason the owner is not able
to install closets and connect with the
sewer, the city does this, charging it as
a lien against the property and per-mitting
the property owner to repay
in monthly installments. All surface
closets are cleaned weekly by the city.
No one can conduct the business of
washerwoman in the city of Asheville
without a permit from the Department
of Health. The homes of the washer-women
are inspected and graded.
Asheville has learned to place the
proper relative estimate upon her gov-ernmental
activities, and has had the
wisdom to recognize that the public
health is of the first importance. Ashe-ville
has also learned that the living
conditions of a city are of the first
consideration, and the position which
she occupies as the best governed city
in North Carolina is due largely to the
fact that her ideal of municipal gov-ernment
and progress is expressed in
terms of public health and social
soundness; physical well-being and
right living; a wholesome atmosphere,
physical and moral; a civic conscience,*
concerned with every part of the com-munity
life. In other words, Ashe-ville
puts first things first.—A. W. Mc-
Alister.
ANOTHER KNOCK-OUT
In former times whiskey was re-garded
as the only remedy for snake-bite
and a bad cold. As pneumonia
was commonly regarded as the out-crop
of a bad cold, whiskey was like-wise
regarded as the sovereign remedy
fo: .^.neumonia. But the doctors are
shelving liquor even for the treatment
of this more serious form of the bad
cold. The United States Public Health
Service is sending out bulletins in-tended
to safeguard the people in this
season of pneumonia, and the bulletin
contains information of a valuable
kind. A list of causes contributing to
pneumonia is given, and alcohol is
specified as one of the most important
contributing agencies. It is stated
that alcohol is indeed the handmaiden
of pneumonia and there is none more
sure or certain of success, especially
if liberally and continuously used. The
old snake-bite remedy is being knocked
out everywhere, and it is well that
North Carolina is even fairly weaned
from thoughts of it.—Charlotte Ob-server.
T ,'l , I , l,,.l .1,1
PUBLIC HEALTH
AND SANITATION
TEACHING HEALTH BY MOTION
PICTUKES
How Public Health is Being Taught in
Kural Districts by Means of Trar-eling
Motion Pictures
Wahrbn H. Booker, C.E.
Chief of the Bureau of Engineering and Education.
Yj] IRCUS day in the city is getting
^^ to be a scarcely more important
^^ event than Motion Picture
Health Day at the country cross-roads.
Yes, real genuine motion pictures. Not
stereopticon lantern slides nor magic
lantern pictures, nor a gas-lighted
lantern, but a fully equipped portable
motion picture machine of the very
latest type with a powerful electric
lighting plant which travels about
from place to place in a large auto-mobile
giving intensely interesting
presentations of the health problem
by means of motion pictures.
Yes, there are comic films, too. Just
as all work and no play is a bad thing,
so all health and no comic films would
not make a good program.
It usually takes about twenty to thir-ty
minutes after arriving at a school-house,
church, or hall to set the mo-tion
picture machine up, hang the cur-tain
or screen, and run the cable from
the electric lighting plant, which ordi-narily
remains stationary in the car,
through a door or window to the mo-tion
picture machine in the hall. When
an entertainment is given in the day-time,
it usually takes a few minutes
longer to darken the windows by
means of black curtains. In the eve-nings
in warm weather the entertain-ments
are frequently given out of doors
in the open air.
Special provisions are made for
lighting the schoolhouse, church, or
hall, as the case may be, by means of
strings of incandescent lights opera-ted
at will by the lecturer from the
switchboard of the machine.
Besides the regular motion pictures,
a Victrola is carried along to provide
a preliminary musical program while
the audience is gathering, as well as
to furnish appropriate music while the
comic films are running. While the
health films are on the screen, the
lecturer in charge delivers a running
lecture, as it were, at suitable times
and places throughout the pictures.
After each entertainment comes one
of the most valuable features of this
work, the distribution of free health
literature. During the entertainment
an exhibit of free health literature is
provided in the hallway or some con-venient
place nearby. After seeing
motion pictures dealing with typhoid
fever, tuberculosis, care of the teeth,
malaria, mosquitoes, flies, care and
feeding of babies, and other health
subjects, many persons in every audi-ence
become very much interested, and
want to learn still more about such
things. For such, and for such only,
is provided a limited quantity of free
health literature by this Board, to-gether
with other literature so gener-ously
provided for the occasion by the
Metropolitan Life Insurance Company
and the Colgate Company.
This outfit does not have to travel
out from cities and towns having ho-tels
as a base of supplies, nor do the
lecturer and machinist thrust them-selves
upon the charity, generosity, or
kindheartedness of the good people in
whose community they are working
THE HEALTH BULLETIN 21
for their board and room. Complete
camping, cooking, and sleeping out-fits
are carried along as a part of the
regular equipment. The accompany-ing
cut shows the outfit about to break
camp in the morning. The simple yet
strenuous outdoor life with plenty of
exercise and all its fresh air are ex-emplified
by these apostles of good
health by example no less than by
precept.
By means of the car, two places can
be visited a day, and motion picture
are used as announcements and occa-sionally
to supplement the teachings
of the health films. As a rule, a good
evening's entertainment is found to
consist of from five to six reels of
pictures, lasting from sixteen to twenty
minutes each. Ordinarily, a program
consists of a good scenic, comic, or
western film, followed by three health
films and concluded with a comedy.
The Board has a sufficient number of
films to give at least three complete
programs, and the usual plan is to go
IX CAMP
A complete camping outfit renders the lecturer and machinist independent of hotels and
boarding-hotises
health entertainments given at at least
twelve points a week. Occasionally in
large places these entertainments are
repeated one or more times at a place,
depending upon the population present
and the size of the hall. During the
country fair season the outfit is sup-plemented
with a large tent, seating
three hundred or more people, and a
continuous entertainment is carried
on as a free attraction of the fair dur-ing
the entire fair period.
Just a few lantern slides are used
in connection with the work, and these
to a county and give substantially the
same program at twelve different
places and then return to each of
these same twelve places one week
later with a complete change of pro-gram,
and again two weeks later with
another complete change of program.
No rental charge is made by this
Board for the use of the outfit. It is
loaned free of charge to any county in
the State having reasonably good
roads. For the present the only re-quirements
to secure a three-weeks
health campaign in a county are, first.
22 THE HEALTH BULLETIN
to providt at least $90 to pay for the
first week's operating expenses, so
that the first series of health enter-tainments
can be given free, and, sec-ond,
to select twelve or more advan-tageously
located points where such
motion picture health entertainments
can be given, and, third, to cooperate
with this Board in a thorough prelimi-nary
advertising campaign throughout
the county.
either by subscription or otherwise,
making admission to the entertain-ments
free, or they may charge an
admission fee. This Board discour-ages
the admission fee idea, and en-courages
counties and communities to
make these entertainments free to the
public wherever possible, for two rea-sons:
first, because by charging even
a small admission fee a certain class
of people will remain away, and as a
ENJOYING THE "HEALTH MOVIES"
Part of the audience at a typical Motion Picture Health Entertainment
In regard to providing the opera-ting
expenses for the second and third
weeks, this is usually done in one of
two different ways. First, instead of
providing only $90 for one week, as
many weeks may be provided for at
that rate as may be desired; or, sec-ond,
the various communities in which
the first week's entertainments are
given may be counted upon to provide
their share of the necessary operating
expenses for the return engagements.
rule this is the very class of people
that need such instruction most; and,
in the second place,, by charging an
admission fee more money is taken
away from the community than is
asked for.
In any county where provision is
made to meet only the first week's
operating expenses, this Board will
be perfectly willing to assume the re-sponsibility
for carrying on the work
during the second and third weeks.
THE HEALTH BULLETIN 23
The quality of these entertainments
has invariably been found to be such
as to commend them sufficiently to
cause those seeing the first entertain-ment
to ask that it return again and
again.
In regard to providing the necessary
operating expenses of $90 for the first
week to secure the outfit, this may be
done in any one of a number of ways.
It has been done in one county by a
single philanthropic individual, in an-other
by one man armed with a sub-scription
list; in another by the county
board of education, and in another by
the county board of commissioners.
Where any or all of these methods
fail, ingenious public-minded persons
will doubtless work out other methods
of securing the necessary $90 for the
first week's work, after which, if it is
desired, this Board will be responsible
for the second and third week's cam-paign.
This Board will be glad to answer
by correspondence any questions in re-gard
to further details of this work.
HOOKWOEM DISEASE
Its Cause, Core, and Prevention
OOKWORM is one of the most
common diseases in North Caro-
'^" lina. Ordinarily it does not man-ifest
itself in any startling or spectacu-lar
manner, like smallpox or toothache,
but gradually reduces the strength, vi-tality,
and efficiency of the unsuspect-ing
victim and makes him subject to
many other more serious ailments and
diseases. Its victims are usually chil-dren
and young people. It is estimated
that about one-third of our school chil-dren
and about one-fifth of our adults
are afflicted with this disease. The
reason for this difference is that chil-dren
more than older people as a rule
go barefooted in summer, and it is by
going barefooted more than any other
way that hookworm disease is con-tracted.
Hookworms are tiny, round, intes-tinal
worms about a half an inch in
length and about the size of an ordi-nary
No. 30 or No. 40 cotton sewing
thread. These little worms have
hooked or bill-shaped mouths by means
of which they hook or attach them-selves
to the inside of the intestines,
hence the name, hookworms. In this
position they suck blood from the in-testines,
cause them to bleed, and in-ject
small amounts of poison into the
sores or wounds they make. While
thus attached to the intestines the fe-male
hookworms deposit large num-bers
of tiny eggs. These eggs are so
sma 1 that they '^an be seen only with
a microscope. They do not hatch in
the intestines, but are carried on out
of the body and deposited with the
fecal matter at every bowel movement
of the victim. Under proper conditions
of heat, moisture, and air these hook-worm
eggs hatch out into tiny mag-gots.
Now, should a barefoot person
soil his foot with some of this fecal
matter or nearby polluted soil, these
tiny worms would at once begin to
burrow into the skin and set up what
is commonly known as "ground-itch"
or "dew-itch." Once these tiny hook-worms
get into the skin they are taken
up by the blood and finally find their
way to the intestines. Here they at-tach
themselves to the walls of the
intestines like their parents and begin
sucking blood and developing into
adult hookworms. In about two months
after the case of "ground-itch" or
"dew-itch" the infected person begins
passing hookworm eggs with every
bowel movement.
Country schools without sanitary
privies are probably the most common
sources for the spread of hookworm
disease. At such schools the boys are
usually required to retire to the woods
in one direction from the schoolhouse
and the girls in another. By such
means one hookworm infected family
may very readily expose the entire
school to infection.
24 THE HEALTH BULLETIN
The Damage From Hookworm Disease
The damage done by hookworm dis-ease
depends upon the severity and
frequency of the infection, A slight
infection decreases the victim's
strength and vitality only slightly. A
heavy infection or repeated infections
do a much greater harm. People thus
infected cannot keep up with their
companions either in work or in play,
and are frequently abused and ridi-culed
and called "lazy," when they are
simply exhausted because hookworms
are sapping their strength. Such peo-ple
deserve sympathy and help instead
of ridicule.
People whose strength and vitality
are lowered for whatever reason are
more disposed to contract other dis-eases,
such as colds, pneumonia, tuber-culosis,
typhoid, and others. While
hookworms rarely kill people directly,
they so weaken them that other dis-eases
which a healthy person would
ordinarily ward off prove fatal to the
hookworm victim.
In the case of little children, hook-worms
frequently stunt their growth
so that they are unable to keep up
with their school work. Finally they
become so languid and discouraged
that they give up school work in
despair.
How to Recognize Hookworm Disease
Besides the characteristic symptoms
and effects of hookworms already de-scribed,
the disease is usually recog-nizable
to physicians or laymen by the
anemic, pale, run-down condition and
bloodless appearance of the victim,
particularly if he admits having had
"ground-itch" or "dew-itch" within the
past few years or has been in the habit
of going barefooted during the summer
time. In other cases, slow-healing
ulcers persist; the hair is dry and
scant, especially the beard and that
in the arm-pits; the face and ankles
are often swollen, and the abdomen is
prominent, giving rise to the term
"pot-belly." In severe cases the ap-petite
may often be perverted and the
victim will eat coffee grounds, soot,
clay, etc., hence the term "dirt-eaters."
The presence of hookworm disease
may be definitely known by sending a
specimen of the morning bowel action
to the county health officer or to the
State Laboratory of Hygiene at Ra-leigh,
where a microscopic examination
for hookworm eggs will be made, free
of charge, provided that the specimen
is properly marked with the patient's
name and sent in a tight tin box. An-other
way of diagnozing the disease is
to take the simple treatment described
below and look for the hookworms
which, if present, may be found by
carefully washing and straining the re-sulting
bowel action through cheese
cloth.
Hookworm Disease is Easy to Prevent
In order to prevent hookworm dis-ease
everybody should wear shoes the
year round. Everybody should use
sewers or sanitary privies, which
would not only protect against hook-worm
disease, but also against typhoid,
cholera, dysentery, and summer com-plaint
among babies; and every person
infected with hookworms should take
the treatment for the disease.
A Good Privy
Of course the best thing for the in-dividual
who has hookworm disease is
to be cured—the sooner the better-and
the best thing for those who wish
to guard against the disease is to wear
shoes, but the most far-reaching gen-eral
health precaution is to build good
privies.
Perhaps the simplest and best type
of privy for the money is the so-called
"pit type." It consists of a substan-tial
fly-proof privy weatherboarded
tight down to the sills all around, and
is set over a small pit or hole in the
ground. This pit should be from two
to four or five feet deep by two or three
feet square. Almost any convenient
size or shape of pit that can be covered
by the privy will do. Special care
THE HEALTH BULLETIN 25
should be taken to see that the privy
sits down close all around and, as a
further precaution, earth should be
banked up around the edge of the privy
so as to make it absolutely dark and
fly proof. A flap door should fit down
over the hole in the seat. In the
course of a few years, if the pit is
found to be filling up, a new pit should
be dug near by and the privy moved
over it, using the earth from the new
pit to fill up the old pit and to bank
PIT PRIVY
A good, cheap type of privy for rural use. Note
it is will huilt close down to the ground all round,
which excludes flies from the pit. The pit may be
2 or 3 feet square by 3 or 4 feet deep.
around the lower edges of the privy.
Such privies should be located at least
one hundred yards from any well or
spring and on lower ground, so that
the drainage is in no case toward a
well or spring.
Hookworm Disease Easily Cured
Besides being easily prevented, hook-worm
disease is also easily cured. The
treatment is usually given as follows:
Eat little or no supper in the evening
and take a good dose of Epsom salts
before retiring. As soon as the bow-els
have acted in the morning, take
half the quantity of powdered thymol
prescribed with a little water, and lie
on the right side for half an hour to
allow the thymol to quickly pass out
of the stomach into the intestines.
Two hours later take the remainder of
the thymol and again lie on the right
side. This thymol will cause the hook-worms
to loosen their hold on the in-testines.
Two hours after taking the
second half of the thymol, take an-other
dose of Epsom salts together
with a cup of hot, strong coffee with-out
sugar or cream. This will expel
the hookworms and the thymol re-maining
in the intestines.
In the majority of cases two treat-ments
like the above, taken a week
apart, are necessary to expel all the
worms. The total amount of thymol
given at a treatment should depend
upon the size and weight of the pa-tient.
In general, about one grain is
given for every three pounds of weight
of the patient. Thus, a sixty-pound pa-tient
w^ould be given twenty grains in
two doses of ten grains each. Special
care should be taken by the patient not
to eat or drink any alcoholic drinks,
patent medicines containing alcohol,
gravy, butter, milk, fat or oily foods
during the day of the treatment and
the day before, as such substances are
dangerous in combination with thymol.
WHY IS A TONSIL?
Modern medical science has proved
that the tonsils are the cause of many
grave disorders. When diseased they
may cause not only bad breath, sore
throat and deafness, but many serious
affections commonly known as rheu-matism,
neuralgia, pleurisy, infection
of the lungs, tuberculosis, appendicitis,
ulcer of the stomach, heart disease,
kidney affections. These throat glands
are the frequent open doors to germ
invasions whose poisons may pro-duce
hardening of the arteries. Better
slaughter a hundred innocent-looking
tonsils than run the risk of sickness
and premature death by harboring one
that is guilty.
SPITTIJVG UNNECESSARY
Spitting is a thoroughly unnatural
performance and indicates an abnor-mal
condition. No animal spits, save
rarely to defend itself against or show
its disgust for an enemy, and it is,
therefore, a most undeserved libel upon
the animal creation to call a man a
beast for expectorating.
Saliva is valuable—so valuable, in
fact, that it cannot be bought for love
or money, as a product of any labora-tory
in the land. Besides, its use in
digestion (if we take time to make use
of it), serves as a constant cleanser
of the mouth, and if we lived health-fully
otherwise, would serve to keep
our teeth in perfect condition. The
body never produces it in wasteful
amount save to counteract and wash
away some harmful substance intro-duced
into the mouth.
The most frequent cause of irrita-tion
to the mouth and throat, and
therefore the most frequent cause of
spitting, is tobacco. Chewing of the
weed is a little out of fashion at pres-ent,
and there is less expectoration in
consequence, but the smoke from to-bacco
is also an irritant, and an over-production
of saliva follows in Nature's
effort to soothe and cleanse the delicate
tissues. From its constant use a
chronic irritation of the throat is also
produced, accompanied by an overse-cretion
of mucus to protect the injured
surfaces. We must either swallow
this excess or discharge it from the
mouth.
The spitting which accompanies a
cough may be a more serious matter
for all concerned. The material coughed
up should never be swallowed, and ex-pectoration
is, therefore, unavoidable
for the welfare of the cougher. For
the welfare of others it is necessary
that the sputum should be deposited
in a receptacle which can be burned.
—
James F. Rogers, M.D., in Physical
Culture.
GUARD TOUR HEALTH BY WATCH-ING
YOUR KIDNEYS
Over 600,000 people in the United
Stattvj die annually from preventable
diseases through ignorance or neglect
of ordinary precautionary measures.
This is due in a very large measure
to the sedentary life led by such a large
proportion of our business men. They
overexercise their brain, underexercise
their bodies—eat and drink too often
and too much—burn the candle at both
ends, and in many needless ways bend
and break the laws of health, the ob-servance
of which would prolong and
make profitable the lives of a vast army
which man pushes on to destruction.
In this day of advanced scientific
medical knowledge and research, it is
possible for one to keep close tab on
one's physical condition, and the wise
and prudent man (or woman) will now
at fairly regular and not infrequent
intervals submit himself for a physical
examination or arrange for some satis-factory
inspection that will evidence
the normal and abnormal status of his
THE HEALTH BULLETIN 27
physical machine, and not wait until
an evident loss of energy and vitality
warns him that some one of his vital
organs is not doing its worli thorough-ly
and well.
Dr. G. A. DeSanto's Saxe, a leading
authority, says: "The urine offers the
greatest possibility for an insight into
the workings of the human system."
Dr. Purdy, another high authority,
says: "Through urinalysis alone can
an almost daily increasing number of
diseases be determined, their intensity
be gauged, their progress towards re-covery
or tendency towards a fatal
termination be predicted. No serious
disease can be in progress without
giving rise to more or less marked
changes in the character of the urine."
Dr. Lukins says: "The condition of
the urine reflects the health or ill
health to a greater extent than any
other organ in the body."
Dr. William A. Evans, former Health
Commissioner of Chicago, than whom
there is no greater authority on pre-ventive
medicine, says: "In my judg-ment,
the plan of periodic examinations
of the urine will prove of great value."
Diabetes, Bright's disease and its
many complications, such as hardening
of the arteries, uremia, various heart
diseases and diseases of the bladder,
are first usually detected by system-atic
and periodic analyses of the urine.
According to the United States
census report, there are over 130,000
deaths in this country annually from
diabetes and Bright's disease alone,
and all authorities agree that a great
majority of these could be prevented or
postponed for years if the impairment
were detected in time—that is, in their
early stages.
Most forms of kidney diseases can
be cured if recognized and treated in
their early stages.
No period of life renders one im-mune
from diabetes or Bright's dis-ease.
Bright's disease, especially, yields
readily to treatment if discovered in
its earlier stages. A thorough and
complete microscopical and chemical
analysis of the urine—and this only-will
determine positively either the ex-istence
or nonexistence of this dread
disease.
The wise man of the future will re-cognize
the wisdom of keeping correct
tab on his physical as well as finan-cial
condition. He will recognize the
fallacy and danger of drifting along in
fancied security and will at regular
and stated times take stock of his phys-ical
resources.
"MAKE HEALTH CATCHING"
It was said by Ingersoll that he
could have made a better world than
this by making health catching instead
of disease. If we learn to obey hygien-ic
laws there will be no catching dis-eases,
and health will spread and pre-vail
everywhere. This world was
meant to be better than it is, and it is
only our ignorance, indolence and per-versity
that prevent it.
While no means of improvement
should be neglected, the largest and
surest returns will be secured by
dealing with the children. Teach
them hygiene and sanitation from in-fancy
up. Inhibit child labor every-where
and enforce the law. Let there
be medical inspection of the schools,
securing ventilation and providing for
the correction of malformations, bad
teeth, defective eyesight and for regu-lar
physical training. Insist on an ad-equate
playground for every school-house,
and for the best, most useful
development of the child, both intel-lectual
and physical, combine manual
and mental training. With these meth-ods
universally carried out for a gene-ration
many present-day problems will
vanish.—Cincinnati Enquirer.
The death rate among children under
five years old, if allowed to prevail
among hogs and cattle would finan-cialy
ruin the breeder.
28 THE HEALTH BULLETIN
THE PACE THAT KILLS
Eational Living Eeconimended as a
Medicine Worth Trying
^7=T|0CT0RS have told us often in late
_ years that our pace is too fast
—
'^™ that we are living not wisely but
too well. Insurance companies, from
motives that are entirely obvious, are
urging reform; lately they have united
in an effort to find out precisely what
is wrong with our manner of living
and to provide a remedy.
To that end, the Life Extension Bu-reau
of New York, through Dr. Ly-man
Pisk, medical director, has been
making an investigation. A group of
1,000 skilled mechanics was examined
and later another group of 1,000 clerks.
The object, of course, was to compare
the health of men who live active
lives with the general health of men
whose business is of sedentary char-acter.
It was found, according to word
from the Doctor, that the mechanics,
as a whole, were little, if any, better
off than the clerks. The active work-ers
presented fewer cases of heart dis-ease,
but more cases of thickened ar-teries.
Bad blood pressure was slightly
more prevalent among the clerks than
among the factory employees, but the
latter showed twice as many cases of
kidney trouble as the former. They
had more lung impairment, too. More
than half the members of the groups
were partaking daily of unsuitable
diet. Doctor Fisk says further about
the results:
"I feel justified in asserting that the
evidence of widespread premature
physical decay, which is suggested by
our vital statistics, is to a considera-ble
degree confirmed by actual exami-nation
of large groups of supposedly
healthy young people. Thousands of
people are slowly and inevitably pre-paring
for physical breakdown or pre-mature
death, and there can be no
more important work for modern med-icine
than to bring such cases, as early
as possible under proper hygienic or
medical guidance."
And, he adds, "That there is some
particular influence at work causing
the upward trend in mortality from
organic diseases, seems probable. It
may be found in our rapid industrial
and social evolution, bringing about a
condition of widespread prosperity and
lavish expenditure—this relatively ex-tending
to the comparatively small
wage-earner in the factory."
This is not saying much that is help-ful.
It is too vague to be of apprecia-ble
service. But it does prescribe
simpler and more rational living, and
that surely is a medicine worth try-ing.—
The Dodge Idea.
The United States is at the present
time spending more than thirty-three
million dollars yearly for the cure and
care of patients afflicted with mental
disease, and comparatively nothing for
prevention. And yet the perusal of
the report of almost any state hospital
will show that in about 50 per cent of
the cases admitted the mental disorder
is due directly to definite causes which
are clearly preventable. From 5 to 10
per cent more are functional disorders
which probably could have been pre-vented
by early treatment.—Eva Char-lotte
Reid, M. D., After-Care Physician
for California State Hospital.
In the entire realm of preventive
medicine, there is no factor more po-tent
than early diagnosis, first, because
disease is far more amenable to treat-ment
in the early stages, and second,
because early diagnosis affords greater
advantages in preventing the spread ol
infection to others.
Spasmodic cleanliness is better than
no cleanliness at all. But it is cleanli-ness
all the time that makes most for
health, happiness, and freedom from
disease.
THE HEALTH BULLETIN 29
IT COSTS LITTLE TO LIVE A
HEALTHY LIFE
Some people think they cannot live
healthy lives unless they are rich.
This is wrong. It is true that rich
people can do some things for their
health that others cannot, but many
rich people live unhealthy lives be-cause
they buy things which are not
good for them. You may not be able
to have the kind of house you would
like to live in. You may not be able
to work in the factory or store you
would like. You may not be able to
do the kind of work you would like
best, but you CAN make all these
things healthier.
You can keep more windows open in
your home; you can often get the
"boss" to keep more windows open in
the factory or store; you may be able
to move further out of the city where
it costs no more to live; you may be
able to get another job.
Even if you cannot do these things,
you can do others that cost nothing.
It costs you nothing to have your win-dows
open while you sleep. It costs
you nothing to take breathing exer-cises
or to stand, sit and walk erect.
It costs you nothing to have your bow-els
move thoroughly and often.
Almost all of us can take enough
time to eat our meals slowly. The
foods that make us most healthy are
often the cheapest foods. Expensive
foods like meats are apt to be less
healthful.
Remember that we can enjoy cheap
food and grow healthy from eat-ing
it. Here is the list of foods in
which the cheapest are given first and
the dearest last: Glucose, corn meal,
wheat flour, oatmeal, sugar, salt pork,
rice, wheat bread, oleomargarine,
beans, peas, potatoes, butter, milk,
cheese, beef stew, ham, mutton chops,
beef, eggs, oysters.—Irving Fisher.
Keep up the fresh-air habit and the
cold bath this winter.
WHEN PEKUNA WAS AT ITS BEST
Illustrating how a person may very
innocently become an alcohol addict,
the editor of one of our medical jour-nals
tells the following:
One of the most serious cases of
hob-nail liver that the writer has ever
seen was a victim of Peruna in the
days when Peruna contained at least
40 per cent of alcohol; the case was
that of a woman—a temperance worker
of considerable prominence. She had
taken Peruna for a number of years,
in ever increasing doses; she was a
chronic alcoholic; but due to her work
for temperance, her symptoms were
wholly misunderstood by her family
and friends. She finally died of chronic
alcoholism, yet no drop of alcoholic
beverage, with the exception of Peru-na,
ever passed her lips. Post-mortem
examination revealed the real cause
of her death which had been obscure
and which had puzzled the medical
staff of one of the largest hospitals, in
which she spent the last few days of
her life. This was a plain case of ig-norance
which led to the patent medi-cine
habit being established in the first
place and continued to the end.—Ex-change.
TAXES AND TANGLEFOOT
The cattle ticks have been eradi-cated
in Edgecombe, and I understand
the National and State governments
are at our service if a hog has cholera.
Is not the health of the average citi-zen
of the town and county of as much
value as a "bull yearling" or a razor-back
shoat? Why not get a health offi-cer
who is an expert on sanitation?
Give him authority and let him be
such a man as will enforce his regula-tions.
If every person in Edgecombe
was taxed ten cents—hang expense,
make it a quarter—such a person, with
an assistant, could be procured. I
have paid already my quota for many
years in "tanglefoot."—A Writer in
Tarboro Southerner.
fllLDjlYGIENE
FOR THE MENTAL HEALTH OF
CHILDREN
The following brief suggestions are
regarded by experts as among those
essential in promoting the mental
health of children.
Give your child opportunity for a
variety of wholesome activities and
interests.
Train your child to work hard in
some regular occupation suited to his
ability and talents; but to avoid fa-tigue
by alternation of work and rest.
Train your child to give attention to
the present situation.
Train your child to strict obedience
In a few important matters and let
him alone in regard to the unimportant
things.
Avoid conditions that tend to pro-duce
overstrain or precocity. The
special business of a young child is to
grow and to play with other children.
Give your child a variety of well
cooked, wholesome food in ample quan-tity
at regular intervals.
Train your child to healthful habits
of sleep in fresh air, giving opportu-nity
for at least nine hours, and for
more than that before the age of
twelve.
If your child becomes worried or
sleepless, or has muscular twitchings
or the like, consult a competent phy-sician
at once.
Take advice of a competent person
concerning the peculiar, sensitive, or
nervous child, in order to correct a
possibly bad inheritance by proper ed-ucation
and environment.
The best method of training is by
example.
INFANT MORTALITY
There are two thousand North Caro-lina
babies—one out of every five born
in the State—that die annually under
one year of age. This is lamentable.
And some of this mortality is due to
conditions that should be bettered
rather than to a merciful Providence
who is often incorrectly, though sub-missively,
credited with the untimely
death of the little ones. Undoubtedly
there is many a Rachel among us,
weeping for her children, whose arms
should never have been robbed and
whose tears should never have been
shed.—Biblical Recorder.
"BABY" JONES
"I want my given name on the cer-tified
copy of my birth record, not
'Baby,' " wrote an indignant young
lady who lived out of town and ^vho
had sent fifty cents for a certified copy
of her birth certificate which she re-turned
with her letter.
She was informed that the certifi-cate
mailed her was an exact copy of
the original on file in the Bureau of
Vital Statistics, in which she was des-ignated
as "Baby" Jones. As she
has grown to womanhood she natu-rally
desired to substitute her real
name for "Baby." Very much depend-ed
upon this in the young lady's inter-est,
which cannot now be corrected.
Fortunately, this condition has
changed. Doctors and midwives, as
well as parents, have learned to ap-preciate
the importance of putting the
full name of the infant on the original
birth certificate, but occasionally we
still get certificates without the given
name. In case of twins this is espe-
THE HEALTH BULLETIN 31
cially important as to which is first
born, and the only way this can be
decided is by the given name.
Few people recognize the importance
of complete birth certificates, and un-fortunately
those who must suffer as
a result of such inaccurate certificates
are the infants, after they have grown
to adult life. With death certificates
it sometimes happens that the de-ceased
was the only person who could
have given certain required data; but
there is absolutely no excuse for any
missing data on birth certificates.
—
Buffalo Sanitary Bulletin.
MEDICAL I\SPECTIO?f OF SCHOOLS
Medical inspection of schools is a
new project in North Carolina. It has
been taken up by a few of the counties
as an experiment and has proven such
a success that funds have been appro-priated
for the continuance of the
work. Too much importance cannot
be laid upon the benefits that this
work can produce. It is a vital mat-ter
to every community to see that
its school children are in good health.
Under the plan of work which Ala-mance
and Northampton counties have
adopted, inspection of the schools is
made at regular periods and advice
given wherever needed. In this way
each child is kept in good health and
the danger from any epidemic of dis-ease
is practically eliminated.—Wash-ington
News.
DRINK MORE WATER
It is a sad reflection upon human na-ture
that the hard-attained is most
appreciated and pursued. "I send you
to a spring across the street," said a
German physician to an American
whom he had recommended to a water
resort back in America near the lat-ter's
home, "and you drink, maybe,
one pitcherful. I send you six thous-and
miles and—what? You drink it
in tubs!"
A FOOL'S PARADISE
Every year millions of dollars are
spent by the American public for use-less
and often harmful medicines. So
many people who would never im-agine
themselves capable of repairing
an intricate piece of machinery will
undertake to repair the most intricate
machine of all—the human body.
When you are ill—even though your
illness may seem slight—see your doc-tor.
Don't buy a supply of pills or
powders with the idea that they'll cure
you. It is an old saying among law-yers
that the man who tries to attend
to his own case in court has a fool
for a client. That being true, what
could in justice be said of the man who
tries to be his own doctor when he is
sick?
TOUR CHILD'S BIRTHRIGHT
The official registration of its birth,
showing parentage and when and
where born, is the right of every child.
The new born babe being helpless in
the matter, most communities have
placed the duty and responsibility of
the registration of the birth upon the
attending physician or midwife. Under
the circumstances, no physician or
midwife has performed his whole duty
to either of his patients, the child or
the mother, until a properly com-pleted
birth certificate has been regis-tered.
In fact, so great may be the
importance to the child in after years
of having its birth registered that a
physician who neglects his patient's
interests to such a degree as to fail to
register a birth might in all justice be
considered an improper person to hold
a license to practice medicine. Very
probably, as parents grow to appreci-ate
the importance of the registration
of their children's births, the failure
of the attending physician or midwife
to register the required certificates
may become a not uncommon cause of
suits at law for damages.—U. S. Public
Health Service.
32 THE HEALTH BULLETIN
FEESH AIR AND WHY
a^
Let's Have a Little More in Our
Schools and Homes
N unstinted supply of fresh air
in the schoolroom will help get
higher grades, prevent more
failures in class work, more cases of
head .che, colds, sniffles, grippe, and
contagious diseases, keep better order,
and yield the teacher, school board,
and taxpayers greater returns in every
way for the money and energy ex-pended
than any other investment they
BEFORE AND AFTER
TAKING FRESH AIR
than in winter. Disease material dis-charged
from the mouth and nose of
those already affected is quickly scat-tered
and blown away, while, on the
other hand, this same abundance of
fresh air increases our vitality and
ability to resist such diseases. As
soon as we begin to huddle together in
the fall and close down our windows,
up goes the sickness rate. This is
largely because we confine ourselves
in air-tight houses, schools, churches,
and offices. Here we breathe in, in a
more concentrated form, the infection
WANTED—More fresh air in the
curriculum.
can make. Fresh air in abundance
serves the double purpose, first, of
rapidly diluting and carrying off dis-ease
particles coughed up and sneezed
and spit out, and, second, of greatly
building up the individual's physical
vitality or resistance so that he can
successfully ward off attacks of the
above mentioned ailments.
Practically everybody knows that
we have fewer cases of colds, measles,
scarlet fever, diphtheria, whooping-cough,
smallpox, and pneumonia in the
summer-time than we do in the win-ter.
One of the chief reasons for this
is that we indulge in more fresh air
and live out of doors more in summer
WANTED—Mure Nurih Carolina
schouls like this.
given off by others; we swap infec-tions,
as it were, and with reduced
vitality we soon become victims of
colds and other ailments.
Perhaps the best way to admit fresh
air through the window is to place a
board or piece of framed glass from
6 inches to a foot in width and as
long as the window is wide across
the bottom of the window in an in-clined
position, so that when the win-dow
is raised from 5 to 10 inches the
incoming fresh air will strike this
inclined board or glass and be de-flected
upward. This effectually pre-vents
any objectionable drafts.
[VI n
TARPOPOi N. C.
Published bij T/\L/4°RmG\R9LI/iA STATE. B^ARD s^AE^Un
This Bullelin will be asrxt free to arvj atizerx of the 5tcrteupoi\rec[ue5t|
Entered as second-class matter at Postoffice at Raleigh, N. C, under Act of July 16, 1894.
Published monthly at the office of the Secretary of the Board, Raleigh, N. C.
Vol. XXXI JUNE, 1916 No. 3
The Newspapers and Public Health
The Doctors and the Newspapers to Clear the
State of Preventable Diseases
"The doctors and the papers! The health and happiness
of the people of a great State are largely in their keeping.
' Together let us beat this ample field.' Combining their efforts
to a common end—the education of the people in the sane
and safe rules of good health, and to the importance thereof
—
they could in the course of time rid the State of all preventa-ble
diseases. There should be no reason why we could not
have a State clear of disease of a preventable nature. But we
should not be content to stop there. The newspapers and the
physicians should set the higher mark of giving North Caro-lina
the finest health record of any State in the Union. With
the doctors leading the way and the papers urging the people
to follow on, our State might easily be placed at the head of
the list."
—
From an address by Mr. Wade H. Harris, editor of
the Charlotte Observer, at Durham, April 19, 1916.
TABLE OF CONTENTS
The Newspapers and Public Health 33
Editorial 35
For County Hospitals 35
The School Nurse 36
An Open Letter 37
Health and Morals 37
Health Officers Put Ban on Drink 37
The Newspaper and the Public Health 38
Tuberculosis Department 40
Why Doctors Should Report Tuberculosis 40
Contagionand Ignorance.. 42
Will It Pay to Look After Our Health? 42
Personal Hygiene 43
Colds. 43
Malaria and What to Do About It 46
Cancer on the Increase 47
Keeping in Repair (with cartoom 48
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
J. Howell Wat, M.D., Pres., Waynesville
Richard H. Lewis, M.D., LL.D., Raleigh
J. L. Ludlow, C.E., . . Winston- Salem
W. O. Spencer, M.D., . . Winston-Salem
Chas. O'H. Laughinghouse, M.D.,
Greenville
Edward J. Wood, M.D., . . Wilmington
Cyrus Thompson, M.D., . . Jacksonville
Thomas E. Anderson, M.D., . Statesville F. R. Harris, M.D., . . . Henderson
Official Staff
W. S. Rankin, M.D., Secretary of the State Board of Health and State Health Officer.
C. A. Shore, M.D.. Director of the State Laboratory of Hygiene.
Warren H. Booker, C.E., Chief of the Bureau of Engineering and Education.
L. B. McBrater, M.D., Superintendent of the State Sanatorium.
J. R. Gordon, M.D., Deputy State Registrar.
G. M. Cooper, M.D., Chief of the Bureau of Rural Sanitation.
Miss Mary Robinson, Chief of the Bureau of Accounting.
FREE PUBLIC HEALTH LITERATURE
The State Board of Health has a limited quantity of health literature on the subects
listed below, which will be sent out, free of charge, to any citizen of the State as long as
the supply lasts. If you care for any of this literature, or want some sent to a friend, just
write to the State Board of Health, at Raleigh. A postcard will bring it by return mail.
Scarlet Fever.
Baby Welfare.
Save the Baby.
The Child.*
Teeth, Tonsils, and Adenoids.'
How to Live Long.'
Hookworm Disease.*
First Aid in the Home.*
The Health of the Worker.*
Smallpox and Its Prevention.*
A War on Consumption.*
Milk.'
Some Facts About Scarlet Fever.*
A Few Facts About Measles.*
Typhoid Fever and How to Prevent
It.*
How to Build a Sleeping Porch.*
Dental Lectures, t
Dental Hygiene, f .
Anti-Spitting Placards (5 inches by
7 inches).
Anti-Fly Placards (14 inches by 22
inches).
Anti-Typhoid Placards (14 inches
by 22 inches).
Anti - Tuberculosis Placards (14
inches by 22 inches).
* Furnished by courtesy of the Metropolitan Life Insurance Company.
t Furnished by courtesy of Colgate & Company.
No. 12.
D)W
I PUBU5ME.D Sr TML nPR.TA CAJouMA 5TATL BQMgP °XMEALTa1
Vol. XXXI JUNE, 1916 No. 3
EDITORIAL
FOE COUNTY HOSPITALS
Resolntion Urging County Hospitals
for Every County in the State
j^IHE accompanying resolution was
J^ presented by Dr. J. Howell Way,
^'^ President of the State Board of
Health, and unanimously adopted by
the State Health Officers' Association
at their recent meeting in Durham.
In presenting this resolution Dr. Way
said in part:
In our judgment as public health
workers in North Carolina, the time
Often their construction has saddled
finaiicial obligations upon medical men
from which they never ceased to be
burdened with, all because of a certain
pride of profession, or at times a sense
of possible duty, that impelled them
to take the initiative in providing for
the community facilities for the care
of the sick, which duty is a community
duty, and not a duty of the medical
profession as individuals.
There is no more justice in assum-ing
that physicians should erect and
pay for the maintenance of a com-munity
hospital than there exists jus-tice
in the suggestion that lawyers
should build the jails and courthouses,
o. ministers of religion erect the
Resolyed, by the North Carolina State Health Officers' Association, That
in the judgment of this body the time has now arrived for the individual
counties of the State lo provide for the erection and maintenance of local
county hospitals for the care and treatment of the sick as a necessary and
vital part of a proper and advanced health policy.
is now ripe for the separate counties
to provide proper care for their sick
and afflicted as a necessary public
health measure. We believe the sick
of a community should have at least
as much attention as is given the crim-inal
classes! Witness the comfortable
jails built to house our malefactors,
and the luxuriously appointed court-houses
erected in which to try ^ these
same malefactors. Are not the sick
worthy of equal consideration? It has
been said in the past that we were a
poor people and could not afford local
county or community hospitals. If
this was ever true, it is not true now.
By far the large majority of local hos-pitals
in North Carolina for the care
of sick people have been built by phy-sicians
from their limited funds.
churches for the use of the other peo-ple
of a community.
A proper appreciation of the advan-tages
of a modern hospital is one of
the evidences of advanced civilization,
and with this appreciation properly
should also come the disposition on
the part of local communities to make
provision for the care of their sick.
The county is the unit of our govern-mental
system, and the counties should
feel it as much incumbent on them to
make proper provision for the care of
those afflicted in body, as well as for
those whose moral natures are at-tuned
at variance with the established
moral thought of the community. In
other words, let us put it up to the
average county of our great State, that
if the county is financially able to
36 THE HEALTH BULLETIN
spend public funds to provide for the
criminal classes of society, there exists
at least an equally strong if not great-er
series of reasons why those physi-cally
unfit should be cared for. Take
the school inspection work going on
all over the State as an example of the
need of local hospitals. Let the in-spector
note the imperfections of a
given number of children. How many
of them are financially able to go to
some distant city where proper facili-ties
for the operative care of many
such patients are to be had? Once
have a local hospital, and there in-evitably
develops from among the lo-cal
profession men capable, willing,
and anxious to perform the needful
operations for which many people of
our State yet go to distant cities where
ample hospital facilities are to be had.
This costs more money to our citizens
and retards the development of the
local medical profession.
But this is not all. The large ma-jority
of the patients needing surgical
treatment never get such benefits un-less
there is a community hospital.
Are not the boys and girls, the men
and the women of this grand old State
worth the investment of sufficient
county funds to erect and maintain in
every county in North Carolina a com-munity
hospital? We will never be a
fully civilized people until this is done,
and now is the time to make a start
in thus bettering the physical condition
of our people.
THE SCHOOL NURSE
The value of the school nurse is one
feature of medical inspection of schools
about which there is no division of
opinion. Her services have abun-abundantly
demonstrated their utility,
and her employment has quite passed
the experimental stage. The introduc-tion
of the trained nurse into the ser-vice
of education has been rapid, and
few school innovations have met with
such widespread support and enthusi-astic
approval.
The r,eason for this is that the school
nurse supplies the motive force which
makes medical inspection effective.
The school physician's discoveiT of de-fects
and diseases is of little use if the
result is only the entering of the fact on
the record card or the exclusion of the
child from school. The notice sent to
parents telling of the child's condi-tion
and advising that the family phy-sician
be consulted, represents wasted
efloTt if the parents fail to realize the
import of the notification or if there
be no family physician to consult. If
the physical examination has for its
only result the entering of words upon
record cards, then pediculosis and tu-berculosis
are of precisely equal im-portance.
The nurse avoids such in-effective
lost motions by converting
them into efficient functioning through
assisting the physician in his exami-nations,
personally following up the
cases to insure remedial action, and
educating teachers, children, and pa-rents
in practical applied hygiene.
To sum up the case for the school
nurse: She i^ the teacher of the pa-rents,
the pupils, the teachers, and the
family in applied practical hygiene.
Her work prevents loss of time on the
part of the pupils and vastly reduces
the number of exclusions for conta-gious
diseases. She cures minor ail-ments
in the school and clinic and
furnishes efficient aid in emergencies.
She gives practical demonstrations in
the home of required treatments, often
discovering there the source of the
trouble, which, if undiscovered, would
render useless the work of the medical
inspector in the school. The school
nurse is the most efficient .possible link
between the school and the home. Her
work is immensely important in its
direct results and far-reaching in its
indirect influences.
Don't get the medicine habit, and
don't get peeved with your physician
if he tells you that you need to take
things easy and spend more time rest-ing
in the open air, or if he tells you
to change your diet and drink more
water and at the same time does not
give you any medicine to take. In
such a case you will have at least the
consolation that you have an honest
man for your doctor.
THE HEALTH BULLETIN 37
AN OPEN LETTER
A Case IVherein a Friend Becomes a
Dangerous Enemy
G HE following letter is a reply to
an inquiry which is typical of
gPgl many received by the State Board
oi Health, asking if anything can be
done to prevent a certain class of af-flicted
persons from spreading their
affliction:
Dear Sir:—I don't know what to
advise you in regard to your friend
C . I know how uncomfortable
you must feel to have such an un-suspecting,
dangerous person in the
oflice with you, especially if he
smokes, coughs and spits on the floor,
stove and everything else as you say,
and refuses to have any ventilation
whatever. From your description of
his cough and other symptoms, I
should think he ought to be in a sana-torium
right now where he would learn
not only how to take care of himself,
but how not to be a menace to others.
If he were a hog and had hog
cholera, of course the State veteri-narian
would take the very best care
of him and he would see to it that he
did not in any way endanger the re-mainder
of the herd. If he were a cow
and had the foot-and mouth disease,
the federal authorities would be down
there in great shape and not only your
little town, but doubtless j^our county,
and perhaps the entire State of North
Carolina, would be quarantined. Now,
of course, since your friend C is
only a human being and the rest of
you are nothing but human beings, I
don't see any hope for you. The State
Board of Health, of course, would like
to see your friend C have a thor-ough
physical examination just as we
would like very much to have every
person in North Carolina have such
an examination, and if there is any-thing
wrong with him, to have the
defects remedied at once Instead of
endangering his fellow-men.
In one of the counties, a few days
ago, an epidemic of hog cholera broke
out, and had continued four weeks
when an Indignation mass-meeting was
held and, as I understand, a county
board of health for hogs was instituted
who are going to wipe hog cholera out
of the county.
It would, of course, be just as easy
to wipe" typhoid fever, tuberculosis, or
any of the other contagious diseases
out, but human beings are human be-ings
and hogs are hogs.
HEALTH AND MORALS
No social agency is more earnest in
its demands upon the church for co-operation
than is the cause of public
health; no agency, to my mind, offers
a greater return for such cooperation.
Public health asks the church to join
hands with it in giving men better bod-ies,
and it promises that when men's
bodies shall be stronger, their spirits
will be nobler. Public health asks the
church to assist it in making sanitary
the community to which the church
ministers, and it pledges the experi-ence
of the world to show that, when
this is done, none will benefit more
than the church. All things being
even, the healthy man is the moral
man; other considerations alike, the
sanitary community is the spiritual
community.—Dr. Ennlon G. Williams.
HEALTH OFFICERS PUT BAN ON
DRINK
At the annual convention of the
Health Officers' Association of New
Jersey, held recently in Newark, the
following resolution was adopted:
Whereas, alcoholic beverages are
detrimental to health and indirectly
the cause of disease:
Resolved, That the Health Officers'
Association recommend that a cam-paign
of publicity be inaugurated by
the State and local departments of
health for the purpose of informing
the public of the dangers to life and
health which attend the use of such
beverages.
38 THE HEALTH BULLETIN
THE NEWSPAPER AND THE PUBLIC HEALTH
Extracts from an Address by Mr. Wade H. Harris before the
North Carolina Medical Society at Durham, April 19, 1916
Iv^IHE banishment of liquor from the
r^ medicine chest accelerates the
^"^ approach not only to a new and
better standard in public health, but in
the morals of the country. In recent
days the world has stood in shocked
and sorrowful contemplation of the
god of war charioteering through a
continent and leaving an overwhelm-ing
river of blood in his trail, but the
weeping of the widows and the wailing
of the orphans assailing his ears is
only a faint echo against the tumultu-ous
wave of anguish that has swept
over the civilized nations for ages past
in the wake of King Alcohol. Liquor
has drenched the world in a volume of
tears that would cleanse the battle-fields
of all peoples from every crim-son
stain.
The changing condition is not being
wrought because the doctor of today
is possessed of more courage than the
doctor of yesterday, but because he
lives in the light of a better knowledge
and has the assistance of the news-papers
in spreading this light. The
doctor is not making a fight on whis-key
in the prohibition sense of the
word. He is waging a campaign for
temperance and health. It is a fight
for health without alcohol.
It is probable that the most conspic-uous
local service rendered the medi-cal
profession and the State by the
newspapers has been in the typhoid
fever campaign. At the outset there
was encountered a prejudice that bid
fair to balk the efforts of the doctors,
but the papers inaugurated a cam-paign
of education which was attended
with excellent results. The State Board
of Health, through the Laboratory of
Hygiene, manufactured and furnished
vaccine free of charge to the people of
the State, and 12 entire counties were
covered. In these 12 counties 51,824
people were given complete immuni-zation
from typhoid. The typhoid
cases were brought down in those 12
counties from 175 in 1914 to 132 in
1915. In addition to the people treated
in the counties named, fully 50,000
have had treatment by whole-time
health officers and various organiza-tions.
A more striking illustration of the
benefits of vaccination may be ob-tained
by the experience of counties
that conducted vaccination campaigns
and counties that did not. Ruther-ford
County was one of the latter.
The typhoid death rate in that county
increased 300 per cent during the time
that the typhoid death rate in the ad-joining
county of Henderson, that had
conducted a typhoid campaign, de-creased
25 per cent. In consequence
of a campaign conducted in Wayne
County, its typhoid death rate was re-duced
65 per cent. The adjoining
county of Lenoir did nothing, and its
death rate increased 25 per cent. Sta-tistics
for the vaccination campaign in
the State as a whole are not yet avail-able,
but there is little doubt that the
instances cited are fairly representa-tive
of results in other counties.
Enough is known to make sure of the
fact that in the assistance rendered
the State Board of Health in so ma-terially
abating the typhoid fever men-ace
and in so short a time the news-papers
have proved themselves a boon
to humanity.
One of the proudest successes to the
credit of the doctors of North Caro-lina
is found in the establishment of
THE HEALTH BULLETIN 39
the State Sanatorium for the Treatment
of Tuberculosis, and yet it is doubtful
if this success could have been attained
at this time but for the useful work
of the newspapers in creating a public
sentiment in favor of that institution.
Its benefits were persistently exploit-ed,
prejudice was combatted, and the
Sanatorium was popularized through
the educational efforts of the press in
its behalf. The newspapers have also
lent their influence to the general cam-paign
against tuberculosis throughout
the State, and there again the influ-ence
has been powerfully effective.
In still another direction, that of
educating the people to the importance
of medical inspection for the public
schools, the newspapers have proved
an excellent ally of the doctors. The
pie in the sane and safe rules of good
health and to the importance thereof
—
they could in the course of time rid
the State of all preventable diseases,
and that happy condition once se-cured,
a public that should come into
an appreciation of immunity and its
blessings could be depended upon to
maintain it. There should be no rea-son
why we could not have a State
clear of disease of a preventable na-ture.
But we should not be content
to stop there. The newspapers and
the physicians should set the higher
mark of giving North Carolina the fin-est
health record of any State in the
Union. With the doctors leading the
way and the papers urging the people
to follow on, our State might easily
be placed at the head of the list. The
Tlie most important work of the press has been in the battle for good
healtli against alcohol. Where former traditions had it that liquor was
good for eyery ailment that flesh is heir to, the papers have brought the
people to the understanding that it is good for none. In the creation
of a prejudice against alcohol as a medicine, the papers have laid a
foundation upon which the doctors have easy work to build, for, with
alcohol banished, the most common and the most insidious enemy to
public health disappears.
wisdom of this advanced step in safe-guarding
the health and even the lives
of the children has had abundant evi-dence
in a recent outbreak that caused
all the schools and even the churches
in one town in North Carolina to be
closed. During the prevalence of the
epidemic responsible for the closing
of the schools and churches, the over-looked
matter of medical inspection
for the schools received discussion, out
of which, it is to be hoped, much bene-fit
will flow to the entire State, for the
value of the ounce of prevention never
before had a more impressive demon-stration.
The doctors and the papers! The
health and happiness of the people of
a great State are largely in their keep-ing.
"Together let us beat this ample
field." Combining their efforts to fe-common
end—the education of the peo-fight
for a State with the minimum
of conditions productive of disease and
the maximum of health has been more
than half won. The medical and health
organizations have brought about re-sults
out of which should come every
encouragement to renewed endeavor.
The work of the present day has one
tremendous advantage over that of the
pioneers in the good-health campaign
in North Carolina. It has an educat-ed
public sentiment behind it, and it
has an enlightened cooperation. We
are out of the woods. The crest of the
hill has been negotiated, the rougher
places have been left behind, and the
going is good. In the noble task of
giving North Carolina a clean face and
a sound body, God speed to the excel-lent
and capably organized service rep-resented
in this gathering.
WHY DOCTORS SHOULD KEPOET
TUBERCULOSIS
To the Doctors' Adyantage as Well as
to the Patients' and Public's Good.
ijrt|E have seen that the physician
^^ who does not report his cases of
tuberculosis to the Bureau of Tu- ^
berculosis thereby violates the law, and
prevents knowledge of the existence of
a new center of possible infection com-ing
to those whose duty it is to pre-vent
contagion. Such a physician oc-cupies
precisely the same position as
the citizen who would not report a fire
to the fire department through the
alarm box.
One would be led to think, from the
general high character of the medical
profession, that such evasions or vio-lations
of the law would be beneath
physicians. Yet the fact remains, in
this State that physicians are not re-porting
their cases of tuberculosis in
anything like the volume in which
these cases occur. They are doing so
more and more, however.
The question arises, why do not the
doctors report their cases of tubercu-losis?
Here are some of the reasons:
Why Doctors Do Not Report
All doctors do not know tuberculosis
when they see it in its early stages.
The fullest knowledge of the diagnosis
and treatment of tuberculosis is of
recent acquirement, and physicians
who learned their art two or three de-cades
ago, and have been so busied
with practice as to be unable to keep
up a progressive course of study,
simply do not know what may be
termed "the fine points" of modern
diagnostic science with reference to this
disease. It is emphatically stated by
the highest medical authorities that
when the symptoms of the disease be-come
sufficiently advanced for the phy-sician
of this type to recognize them
all hope is past for the patient. Not
knowing the disease, some doctors,
therefore, cannot report it.
Then, there are physicians who be-lieve
that it is not wise to tell a patient
when he has tuberculosis, or con-sumption.
The medical' profession is
limiting more and more the scope of
this practice of secrecy, but it still ob-tains
where much more harm than
good i